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D .;*, ;. A' '.'^.^1. 

Art, Science and 
Politics in the 

Service of 
Public Health 


Digitized by tine Internet Arciiive 

in 2011 witii funding from 

CARL!: Consortium of Academic and Researcii Libraries in Illinois 

D U C E U 

Art, Science and 
Politics in the 

Service of 
Public Health 


a museum journal for the health sciences 

Board of Advisors 

Volume VI ■ Number 2 ■ Summer 1990 

Published by the 

Department of Medical Humanities 

Board of Editors 

Glen \V. Davidson, lilimr 

Linda Keldermans, PuhiKaiums Editor 


Barbara Mason, Cwaloi: We Peamm Museum 
M. Lynne Cle\erdon, Business Manager 

Caduceus i,s published three times a year by the 
Department of Medical Humanities, Southern Illinois 
University School of Medicine. Caduceus is cited in 
Index Medicus and in Medline, the principal online 
bibliographic citation base of the National Library of 
Medicine- (Printed on acid-free paper, effective with 
X'olunic \', Nil 11 

Subscription Rates 

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ubscription conimunic 
to the 

Department of Medical Humanities 
Southern Illinois University 
School of Medicine 
P.O. Box 19230 

SpringTield, Illinois 6279+9230 
Phone (217)782-4261 

Copyright 1990 Tlie Board of Tmstees 
Southern Illinois University 
ISSN No. 0882-7447 

hould be addres.sed 

James Connor 

.Medical Museum 

Lniversity of Western Ontario 

London. Ontario NGA SA5 

M. Patricia Donahue 

College of Nursing 
University of Iowa 

Iowa City, lA 522-i2 

James Edmonson 

Howard Dittrick Museum of Historical Medicine 
Cleveland Health .Sciences Library 
Cleveland, OH 'J4l06 

Michael Harris 

National Museum of American History 
14th Street & Constitution Ave., N.W. 
Wa.shington. DC 20560 

Christopher Hoolihan 

Edward G. .Miner Library 
University of Rochester 
Rochester, NY 14642 

Joel Howell 

Department of Internal Medicine 
University of Michigan 
Ann Arbor, Ml 48109 

Adrianne Noe 
Armed Forces Medical Museum 
Armed Forces Institute of Pathcjiogy 
Washington, DC. 20306 

Gretchen Worden 

Mutter Museum 

College of Physicians of Philadelphia 

Philadelphia, PA 19103 



Art in the Service of Public Health: 
The Illustrated Poster 
by William H. Helfand 




The Poster Collection at the 
National Library of Medicine 
by Lucinda H. Keister 

Evolution of Federal Dietary 

Guidance Policy: From Food 

Adequacy to Chronic Disease 


by Marion Nestle and Donna V. Porter 


0© Exhibits and Conferences 





1 a 5 6^^ 

4. Waltham Hospital Fair. 

A poster by the American art- 
ist C. W. Reed designed to 
raise funds for a hospital in 
1896. (Courtesy of The 
William H. Helfand Collec- 

Art in the Service of Public Health: 
The Illustrated Poster 

The first illustrated posters 
appeared during the 1840s, when 
technological advances in the use of 
large-scale printing machinery permit- 
ted the publication of lithographs in 
more than a single color. Demand 
originally came from two sources: , 
the manufacturers and marketers of 
commercial products, beer, books, 
shirts, corsets and proprietary medi- 
cines; and from promoters of the 
circus, popular entertainments and 
travel to distant lands. Although medi- 
cal subjects were included in early 
designs, their exclusive purpose was 
to publicize products. While a few 
earlier posters were published to raise 
funds for hospitals or victims of chol- 
era and other epidemics in the 
nineteenth century, the first public 
health posters did not appear until 
Wodd War I. 

Precedents did exist, however. 
Broadsides, among the earliest exam- 
ples of commercial printing, often fo- 
cused on health matters and were 
used by local officials to warn the 
populace of impending epidemics or 
to institute corrective or protective 
sanitary measures. These broadsides 
were not illustrated. A seventeenth- 
century plague sign from Ehrfurt, Ger- 
many—two crosses, each with the 


vn/ionah eSoMu^zm. la .^iecu/u/e da &a^ 

word Pest, proclaiming the presence 
of plague in the house on which it 
was to be displayed— is one of the ear- 
liest surviving quarantine signs. 
(Check List No. 1) In 1866, broad- 
sides in Limehouse, England, stressed 
that residents were "earnestly advised 
not to drink any water which has not 
previously been boiled." Likewise, 
Italian authorities posted warnings for 

5. La Journee de Pasteur. 

To help in a fund-raising cam- 
paign for ttie Institut Pasteur 
in 1923, Henri Rapin puth 
lisfied a poster including 
illustrations of Pasteur de- 
signed by contemporary 
artists. (Courtesy of National 
Library of Medicine Collec- 

by William H. Helfand 


recurrent epidemics in the seven- 
teenth and eighteenth centuries. 
Quarantine notices for diphtheria, 
whooping cough, measles, mumps 
and polio were common in towns 
and villages until forty or fifty years 
ago; today they have become sought 
after treasures by ephemera collectors. 

Early Examples 

Although few in number, there are 
examples of illustrated posters on 
health issues before World War I. 
The Spanish artist Ramon Casas de- 
signed a poster claiming to cure syphi- 
lis for the Sanatario para Sifiliticos, a 
private hospital, in 1900. (See cover 
and Check List No. 2) Instead of illus- 
trating the debilitating effects of the 
disease as a warning, Casas drew a 
beautiful woman holding a flower in 
her hand, thereby hinting at positive 
results of a stay at the sanitarium. A 
snake, symbol of disease, crawling up 
the woman's back, was the sole indi- 
cation of the sanitarium's purpose. 
Earlier posters also were commis- 
sioned to announce hospital or chari- 
table fund-raising campaigns. For 
example, posters familiarizing the pub- 
lic with the plight of cholera victims 
frequently emphasized the devasta- 
ting effects of the disease on women 
and children. The Fete Parisienne 
was held in the Jardin des Tuilleries 
in 1902 to raise money for those who 
had been affected by epidemics of 
cholera. The poster presenting details 
on the event showed a mother hold- 
ing her dead child, with an angel in 
the background ready to receive the 

body. (Check List No. 3) As if the 
tragedy depicted by the artist were 
not enough, there was a second grief- 
stricken woman in the background as 

Not all such fund-raising announce- 
ments were so morbid. A delightful 
American poster by C.W. Reed, an- 
nouncing the "Waltham Hospital Fair" 
in 1896, had a benevolent angel reach- 
ing down to look after young patients 
(See frontispiece and Check List No. 4.) 

Posters were, and are, routinely 
commissioned to communicate perti- 
nent details of fund-raising events. A 
good example is French artist Henri 
Rapin's detailed lithograph of a day of 
celebration to benefit the Institut Pas- 
teur in Paris in 1923, marking the cen- 
tenary of the birth of Louis Pasteur. 
(See p. 1 and Check List No. 5.) 
Contributors purchased lapel badges 

6. Soldat. La Patrie Compte 
sur Toi .... 

To warn against infection, 
this 1916 poster by 
Steinlen contrasts the image 
of a healthy soldier at the top 
with another who sits forlorn 
in a hospital as a result of 
his indiscretions. (Courtesy 
of Philadelphia Museum of 
Art: The William H. Helfand ^ 

SUMMER 1990 

to wear on jackets or shirts; each 
small vignette had been commis- 
sioned from a well-known artist, and 
the poster included drawings by 
Georges Barbier, Jean Beraud, Albert 
Besnard, Maurice Denis, Abel Faivre 
and Poulbot. These badges, too, 
have become prime examples of med- 
ical ephemera. Rapin's poster pro- 
claimed the most exalted faith in 
medicine, calling the institute's labora- 
tories temples of the future, and bath- 
ing Pasteur in an unrestrained 
religious glow, in stained glass, with 
angels and halos present in several of 
the designs." 

Venereal Diseases 

By the turn of the century, the 
value of posters in creating demand 
had been well established. When hos- 
tilities began in Europe in 1914, au- 
thorities on both sides of the conflict 
employed posters among other means 
of communication to accomplish mul- 
tiple purposes. At first the drive was 
for men and money, and in Great Brit- 
ain and the United States, where there 
was no compulsoiy military service, 
for conscription. Patriotism also beck- 
oned in later posters urging citizens 
to aid fighting men by sacrificing com- 
forts to ease demands on the troops. 
Next came requests for help, such as 
the need for blood donations for 
wounded soldiers, orphans and refu- 
gees. Finally, there were appeals to 
support the overwhelming efforts 
which ultimately ended the conflict." 

Concern for public health was 
prominent in posters in the latter 

years of the war. Military authorities, 
following the example set by Napo- 
leon, took it as given that their armies 
marched on their stomachs, but also 
concluded that soldiers had to be in 
good health to travel at all. Histori- 
ans can point to numerous crucial bat- 
tles and campaigns in which deaths 
from disease far outnumbered those 
from fireamis. For example, in 
Hernando Cortes's sixteenth-century 
conquest of Mexico, smallpox devas- 
tated the ranks of the Indians. In 
Napoleon's 1799 expedition to Egypt, 
there was greater worry over the 
plague epidemic that had hospitalized 
fighting men at Jaffa than concern for 
the advancing Turks. "^ 

7. L 'Hecalombe. La Syphilis. 

A stril<ing poster by Belgian 
artist Louis Raemakers, 
stiowing a woman, ttie image 
of sypliilis, tiolding a skull in 
her hands among rows of 
graves. (Courtesy of Phila- 
delphia Museum of Art: The 
William H. Helfand Collec- 


In view of such experience, mili- 
tary leaders have been required to 
consider potential ravages of disease 
in planning their battle strategy. Dur- 
ing the major wars of the twentieth 
century, responsible agencies have 
made serious efforts to instill a con- 
cern for health in the minds of their 
soldiers, sailors and marines. Vene- 
real diseases have been the major tar- 
gets. In the charged atmosphere of 
war, syphilis and gonorrhea threaten 
military efficiency as well as personal 
health. In addition, the intertwining 
of moral with medical issues— a com- 
bination that is nearly impossible to 
separate when sexually transmitted 
disease is the subject—suggests to 
many observers that infected soldiers 
also symbolize moral failure and so- 
cial decay. 

As the conflict in Europe escalated 
in 1914, propaganda campaigns were 
mounted by both sides with films, lec- 
tures, pamphlets, demonstrations and 
other media marshalled to create nec- 
essary awareness. Not surprisingly, 
posters were among the heaviest artil- 
lery in these propaganda campaigns. 
By their very nature, posters were ide- 
ally suited for this purpose. Patrio- 
tism, along with fear, was the chief 
theme used by artists in creating the 
earliest poster images that would be 
exhibited to both servicemen and the 
general public. One of the more dra- 
matic of these early examples was 
published in France in 1916 by 
Theophile-Alexandre Steinlen. (See 
p. 2 and Check List No. 6.) Neither 
the words syphilis nor gonorrhea are 
mentioned, their use being too ex- 

plicit for the sensibilities of the gen- 
eral public at the time. However, the 
illustrations of the woman embracing 
and the physically debilitated soldier 
on his hospital bed leave no doubt as 
to the message. On a tombstone in 
the center is the direct patriotic appeal: 

Soldier, the country counts 
on you— 

Keep healthy. Resist the 

of the street where a sickness 

dangerous as the war awaits 

It carries its victims to decay 

to death, without honor, with- 
out happiness.... 

Steinlen's poster incorporates two 
recurring images frequently found in 
campaigns against venereal disease. 
The first image is of the woman, in- 
variably presented as the cause of the 
problem, and the soldier or sailor is 
admonished to be continually on hLs 
guard against the evils she represents. 
Woman personified continued as a 
main target during World War II as 
well, but has not surfaced widely in 
contemporary AIDS campaigns. The 
second image is of death. At the bot- 
tom of the Steinlen poster is a skull 
with crossbones, a powerful and fear- 
ful symbol. 

Louis Raemakers, the Belgian artist 
whose political caricatures con- 
demned German atrocities in World 
War I, used the skull in his poster, 
"L'Hecatombe," or the sacrifice of 

11. Juke Joint Sniper. 

Warnings against associat- 
ing with loose women were 
common themes in American 
World War II anti-venereal 
disease posters. (Courtesy 
of National Library of Medi- 
cine Collection.) 

SUMMER 1990 

many victims. (See p. 3 and Check 
List No. 7) In this poignant warning 
Raemakers illustrated a pale woman 
with spider-like hair wearing a black 
cloak and holding a skull in a posi- 
tion that seems to equate death with 
sex. The starkness of Raemakers's 
image fully captures the menace of 
the dread disease, and crosses in the 
field add impact. "L'Hecatombe" is 
one of the most powerful and striking 
posters ever made. A French poster 
by Theodoro, "La Syphilis est un 
Fleau Social, Ses Victimes sont In- 
nombrables" (Syphilis is a Social 
Plague, its Victims are Beyond Count- 
ing) was only slightly less dramatic in 
its illustration of a couple kissing be- 
fore a grinning skull. (Check List No. 
8) Lucien-Achille Mauzan, a prolific 
artist who was an active poster de- 
signer in France, Italy, Spain and Ar- 
gentina, placed two death-like figures 
behind a bride and groom, thereby 
making use of the same imagery to 
create a frightening image of venereal 
disease intmding on an otherwise 
happy occasion. (Check List No. 9) 

As a serviceable symbol to arouse 
fear, the skull was carried over to ve- 
nereal disease warnings to service- 
men in World War II. "Hello Boy 
Friend, Coming MY Way?," a poster 
by British artist Reginald Mount, was 
but one example, continuing a tradi- 
tion that had apparently been effec- 
tive. (Check List No. 10) The text in 
Mount's poster again blamed the 
woman for creating the problem in 
the first place, warning that the "easy 
girl-friend spreads syphilis and gonor- 
rhea, which unless properly treated 

may result in blindness, insanity, pa- 
ralysis, premaaire death." Attractive 
women certainly could be counted on 
to successfully attract a soldier's or 
sailor's attention, and posters by 
Charles Casa and others took advan- 
tage of this appeal in showing prosti- 
tutes lighting cigarettes in front of a 
bar or leaning against a wall. These 
"Juke Joint Snipers" were identified 
specifically as potential sources of 
syphilis and gonorrhea. (See p. 4 and 
Check List Nos. 11-12.) Even the per- 
fect "girl-next-door" could not be 
trusted; she served as a warning to all 
servicemen in "She May Look Clean, 
But," which contained the warning 
that "pick-ups, good-time girls and 
prostitutes" could be carriers of infec- 
tion. (Right, and Check List No. 13.) 
Perhaps the theme of women personi- 
fying disease reached its high (or 
low) point in an extensive campaign 
directed at U.S. servicemen during the 
1940s, with the recurrent headline 
"Dames and rum don't mix!" 

Patriotism, fear and an advised war- 
iness of women were not the only 
themes used in the hundreds of post- 
ers employed in venereal disease cam- 
paigns, particularly by the Americans, 
during World War II. Frequently, 
posters had no concept behind them 
other than the repetition of simple 
warnings on the harsh consequences 
of venereal disease. These warnings 
were as uncomplicated and as direct 
as they could be, their messages often 
at levels that could be comprehended 
by relative illiterates. One of the 
most elementary examples was a 
poster distributed by the U.S. Navy, 

13. She May Look Clean, But. 

Warnings to servicemen did 
not exempt the girl-next- 
door. Avoiding contact with 
women was the major mes- 
sage in anti-venereal disease 
campaigns in World War II. 
(Courtesy of National Library 
of Medicine Collection.) 


showing simply a pair of dice labeled 
with a "V" and a "D" with the legend, 
"Don't Gamble." (Check List No. 14) 
Another American example by Robert 
Bode presented three bands, on 
which were the acronyms "VE, VJ and 
VD," each band with a smiling or a 
frowning face. (Check List No. 15) 
There was also a poster showing 
Uncle Sam's leg, easily identified by 
its striped trousers, ready to step on 
the letters ""V D." The superfluous 
caption read "Stamp out "Venereal Dis- 
eases." (See p. ^9 and Check List No. 

American posters of this period 
also presented illustrations of ser\'ice- 
men themselves. Two used by the 
Navy were typical: in one a remorse- 
ful sailor looks off into space as he il- 
lustrates the message that "VD Can Be 
Cured But There's No Medicine for Re- 
gret;" and in another, a sailor wearing 
a dunce cap writes repeatedly on the 
blackboard, "I Should Have Gone to 
the Pro Station."*^ (Check List Nos. 17- 
18) Often an object of ridicule, the 
dunce, with his ubiquitous cap, ap- 
peared frequently, as artists used 
humor to make their points. Exam- 
ples present caricatures of a befud- 
dled sailor in front of a pro station, 
asking what it is he is supposed to re- 
member, or being asked whether he 
is taking VD home with him in his 
packed duffle-bag. (Check List Nos. 
19-20) Nor did poster artists neglect 
the GFs favorite reading, comic strips. 
Large-sized versions of the most famil- 
iar characters in the comics were used 
to repeat messages to avoid women, 
or if this were not possible, to encour- 

I=J e; (=> l_l B 1_ I O LJ E F^ C5 A M C: AIS E 





age quick visits to the pro station. 
(Check List Nos. 21-22) 

Venereal disease also was por- 
trayed as an evil equal to the Axis 
powers— Germany, Italy, and Japan 
themselves— a theme used twice in 
posters designed in 1942 by popular 
illustrator Arthur Szyk. (Check List 
Nos. 23-24) (As an aside, it is note- 
worthy that similar warnings were 
used for other diseases. For example, 
the linking of Japanese soldiers with 
malaria as the common enemy— sug- 
gesting that protection was necessary 
against both— was a natural idea for 
war-time propagandists. In an Ameri- 
can poster published in 1943 for use 
in the Far East, .soldiers were admon- 
ished to "Fight the Peril Behind the 
Lines. Between sundown and sunrise 
the malaria mosquito is more deadly 

31. La Syphilis Est Curable. 

Leo Fontan's 1930s poster 
emphasizes that syphilis can 
be cured with proper medical 
attention. The lengthy text 
surrounding the illustrations 
contributes to the overall de- 
sign. (Courtesy of Philadel- 
phia Museum of Art: The 
William H. Helfand Collec- 

SUMMER 1990 

than the enemy.") (Check List No. 25) 
The fact that the military enemy might 
even be a lesser evil in anti-venereal 
disease campaigns was echoed in a 
World War II poster that carried the 
caption, "A German Bullet is Cleaner 
than a Whore." 

If fear, patriotism, wariness, or 
humor could not deter servicemen 
from the dangers of imprudence, a 
major effort also was made to have 
potential victims seek later help. Sol- 
diers were warned repeatedly that un- 
authorized treatment was unreliable, 
one poster suggesting that "No Home 
Remedy or Quack Ever Cured Syphilis 
or Gonorrhea." (Check List No. 26) 
At the same time, however, the avail- 
ability of sulfonamides in the late 
1930s and of penicillin around 1943 
provided cures, especially for gonor- 
rhea. Posters stressed the necessity to 
seek prompt and proper care. (Check 
List No. 27) 

While warnings to servicemen 
were among the most important pub- 
lic health objectives in World War II, 
propaganda accentuating the evils of 
venereal disease also was directed to 
the public which, of course, has been 
equally victimized by syphilis and 
other venereal diseases. Posters for 
the public stressed similar themes, 
warning against exposure and insist- 
ing on proper prophylaxis. (Check 
List Nos. 28-29) In the years since the 
war, the U.S. Public Health Sei-vice 
and its counterparts in other countries 
have continued their public appeals, 
emphasizing the importance of blood 
tests to diagnose venereal disease or 
to have the disease treated by respon- 

sible medical authorities. (Opposite, 
and Check List Nos. 30-31.) Today, 
posters on subjects of sexually trans- 
mitted disease have proliferated as a 
result of the devastation brought on 
by the AIDS epidemic, and the conse- 
quent necessity to use every effective 
means of communication in public ed- 
ucation campaigns. 

Infectious Diseases 

while venereal diseases have been 
the major target of war-time public 
health campaigns, they certainly have 
not been the only ones for which 
posters have been employed. One 
prevalent infectious disease still with 
us, and which probably always will 
be, is the common cold. Everyone is 
familiar with the adage, "Coughs and 
Sneezes Spread Diseases." (Right, and 
Check List No. 32.) Henry Mays Bate- 
man, the popular British cartoonist, 
produced a set of four posters with 
this title for the British Ministry of 
Health in the 1940s, each showing a 
scene where lack of concern for oth- 
ers arouses the wrath of onlookers. 
Measles, mumps and diphtheria re- 
main problems in certain parts of the 
worid, and campaigns have been 
mounted from time to time to call at- 
tention to their importance. (See p. 9 
and Check List Nos. 33-34.) At the 
conclusion of war in 1945, local gov- 
ernment authorities in the United 
Kingdom sent teams to villages and 
rural communities to emphasize the 
importance of immunization against 
diphtheria; posters on their vans sensi- 
tized passersby to the is.sue. 

Coughs and sneezes 
spread diseases 

Trap the germs by using 
your handkcrciiier 

32. Coughs and Sneezes 
Spread Diseases. 

British cartoonist H.M. Bate- 
man produced a series of 
posters on the importance of 
protecting others from possi- 
ble infection; each shows a 
crowded scene, such as this 
one in a draper's shop, in 
which a man or woman 
sneezes. (Courtesy of The 
William H. Helfand Collec- 


Smallpox fortunately has been erad- 
icated, polio is much diminished, and 
the number of tuberculosis cases has 
been greatly reduced, although there 
is now some alarm that tuberculosis 
may be reasserting itself in economi- 
cally depressed areas. Thus, posters 
for these former scourges now pres- 
ent a record of the past. Polio post- 
ers were produced primarily to raise 
money for research. A poster created 
in 1949 by Herbert Bayer for the Na- 
tional Foundation for Infantile Paraly- 
sis is a good example. Commenting 
on contemporary research results in 
1949, Bayer drew a simple hand-held 
test tube to illustrate the title, "A Light 
is Beginning to Dawn." (Check List 
No. 35) 

The majority of appeals for tubercu- 
losis victims also had fund raising as 
their goal, and several of the most ar- 
tistically important of all public health 
posters dealt with this issue. An Ital- 
ian effort by Basilio Cascella, issued 
around 1920, showed a Red Cross 
nurse with her dagger attacking the 
dread cause of the disease, symbol- 
ized by a frightening serpent. (Check 
List No. 36) Cascella's poster raises 
the perplexing question for the artist 
of how to describe a disease such as 
tuberculosis in graphic terms. In addi- 
tion to the serpent. Death personified, 
skulls, snakes, monsters, and extrater- 
restrial figures have been used over 
the years. To a certain extent, it was 
after the discoveries of Robert Koch, 
Louis Pasteur and other microbiolo- 
gists in the nineteenth century that mi- 
crobes and grotesque bacteria began 
to replace earlier visual metaphors. 

A second poster from about the 
same time, by Italian artist T. 
Corbella, used the equally powerful 
imagery of attacking swords to com- 
bat the figure of death. Cleanliness, 
sun, air, rest, proper food, hygiene 
and perseverance were allegorized in 
Corbella's poster to break the sword 
labeled "tuberculosis." (Check List No. 
37) Lionetto Cappiello, an artist 
whose posters were largely promo- 
tions for commercial products, pub- 
lished an excellent example for the 
tuberculosis relief campaign con- 
ducted by the Rockefeller Foundation 
in France from 1919 to 1922. (Check 
List No. 38) In his caricature-like 
style, Cappiello drew a mother hold- 
ing her child as far from an attacking 
snake as she could, while she at- 
tempted to trample the reptile to 
death. The Rockefeller Foundation pi- 
oneered in its leadership, recognizing 
that a great deal of effort was needed 
to aid the French in treating the al- 
most overwhelming number of tuber- 
culosis cases resulting from the 
lengthy and costly war. In their at- 
tack on the public's ignorance of the 
disease and methods to combat it, the 
Rockefeller group brought experience 
in the conduct of mass health educa- 
tion campaigns, using American know- 
how in a country for whom it was an 
entirely new experience. As a major 
aspect of its campaign, the Rockefel- 
ler Commission for the Prevention of 
Tuberculosis in France commissioned 
twenty posters and at least a dozen 
post cards, distributing them freely 
throughout the country by mail and at 
conferences to inform audiences of 

SUMMER 1990 

what could be done about tuberculo- 
sis. Among other poster artists repre- 
sented in the Rockefeller program 
were Louis Raemakers, Georges Dori- 
val and Auguste Leroux. (See p. 10 
and Check List Nos. 39-41.) 

An American poster on behalf of 
the Red Cross Christmas Seal Cam- 
paign during the 1920s promised that 
tuberculosis would be "The Next to 
Go," with the illustration showing the 
protector of his family pushing the 
dread visitor out the door. (Check List 
No. 42) This and other Christmas 
Seal campaigns to solicit contributions 
for tuberculosis research normally re- 
quired a newly minted poster each 
year. Frequently, these posters in- 
cluded the Christmas seal itself in the 
design, and it was common for the art- 
ists to use illustrations of young pa- 
tients, considering them to be a 
forceful means of obtaining contribu- 
tions from prospective donors. 
(Check List No. 43) B.C.G. vaccine, 
and one of its discoverers, Albert 
Calmette, were prominent in several 
French Christmas seal posters. (See 
p. 11 and Check List No. 44.) 

Among the more engaging posters 
on tuberculosis were those designed 
to raise funds for World War I veter- 
ans who had contracted the disease 
while on active duty. Backed by a 
private French group with support 
from the French and American govern- 
ments, the Journee Nationale des 
Tuberculeux was an annual fund-rais- 
ing day, for which leading artists 
were commissioned to create posters. 
Those by Lucien Levy-Dhurmer and 
Abel Faivre are among the more ab- 

sorbing examples in this series. In 
Levy-Dhurmer's poster an ailing sol- 
dier, supporting himself with a walk- 
ing stick under a beautiful spray of 
cherry blossoms, casts a forlorn gaze 
across an impressionistic sea. (Check 
List No. 45) Faivre was best known 
as a popular caricaturist in the early 
twentieth century. He published a se- 
ries of cartoons on doctors in the 
weekly satirical journal, L 'Assiette an 
Beiirre, but he also designed influen- 
tial posters for varied aspects of the 
French war effort, one of which illus- 
trates a weary soldier with a nurse's 
hands on his shoulders. (Check List 
No. 46) A poster by Alfred Philippe 
Roll was published during the war to 
stimulate aid for tuberculosis victims; 
his scene of a nurse and her desolate 
patient was a memorable image in 
this series of fund-raising campaigns. 
(Check List No. 47) Yet another ex- 
ample was the somewhat confusing al- 
legorical design by Charles Jodelet, 
"La Corse a la Mort" (The Race to 
Death), published by the Ligue 
Nationale Fran^aise Contre le Peril 
Venerien in 1926. Jodelet made dis- 
ease into a horse race, giving statistics 
for the number of annual deaths from 
tuberculosis, the clear victor, as well 
as from cancer and syphilis—as 
though there really could be a winner 
in such matters. (See p. 13 and Check 
List No. 48.) Death, draped in a 
white shroud, observes it all through 
a magnifying glass, an hourglass at 
his side. 

There are posters warning of the 
scourges of malaria, typhus and nu- 
merous other infectious diseases and. 



33. Diphtheria is Deadly. 

A British poster, c. 1930, 
stressing the necessity of im- 
munization against diphthe- 
ria. (Courtesy of The William 
H. Helfand Collection.) 


in Third World countries, where sani- 
tation levels are less than optimal, ex- 
amples exhorting the public about 
cleanliness itself. Flies, a universal 
enemy, often receive special treat- 
ment, as do the diseases they transmit 
—dysentery, typhoid and cholera. An 
anonymous Italian poster of the 
1920s, "Guerra alia Mosche," makes 
impressive use of the imagery of 
planes and bombs to point out the 
need to eradicate disease-carrying 
flies. (Check List No. 49). 

As might be expected, malaria ne- 
cessitates continual warnings to em- 
phasize public health measures. The 
approach poster artists commonly 
took was similar to that used for sexu- 
ally transmitted disease campaigns: 
simple graphics and repeated mes- 
sages. One malaria poster encour- 
ages readers to use nets, take 
treatment, and cover arms and legs 
against bites after dusk. (Check List 
No. 50) "Fm Looking For You," an 
anti-malaria poster by Abram Games, 
the artist in charge of the British 
poster program during World War II, 
presented a striking design warning 
of the necessity to protect against the 
mosquito. (Check Lfst No. 51) Of the 
nearly one hundred posters Games 
published during his War Office ca- 
reer, a good proportion were on pub- 
lic health subjects. For example, a 
Games poster with a huge insect dom- 
inating the illustration warned that 
flies "Carry Disease from Filth to 
Food." (See p. 14 and Check List No. 
52.) Not surprisingly, there were addi- 
tional posters by Games on protection 
against venereal disease. His tech- 

nic]ue, involving heavy' use of the air 
brush, gave him better artistic control 
than photographs, and often provided 
an abstract or surreal look to his post- 
ers. In contrast to the simplistic ap- 
proach preferred by the American 
poster artists of the World War II era. 
Games believed that war posters 
should make viewers think for them- 
selves. His dramatic use of syrnbol- 
ism created the most sophisticated 
posters produced during the war. 


Beyond the field of infectious dis- 
eases, posters have been designed for 
other important public health prob- 
lems, such as cancer, cardiovascular 
disease, alcoholism and nutrition. Be- 
cause of the need for early diagnosis, 
cancer has been and continues to be 
a frequent subject. The LI.S. Public 
Health Service has published posters 
delineating cancer's danger signals, 
and has cooperated with the Ameri- 
can Cancer Society to conduct cam- 
paigns stressing early diagnosis and 
warning against cancer quackery. 
(Check List Nos. 53-54) 

As part of a lengthy anti-quackery 
campaign, posters in the late 1930s re- 
flected the limited treatments avail- 
able at the time, presenting simple 
illustrations and cautioning that "No 
Home Remedy, No Tonic, No Special 
Diet, No Salves, No Powders, No Pills 
Ever Cured, Only Surgery, X- ray or 
Radium Can Cure Cancer." (Check List 
No. 55) Statistics also were employed 
in the war on cancer; one poster in 
the late 1930s stated that cancer had 


40. L 'Aigle Boche Sera 

In this 1917 tuberculosis 
poster, French artist George 
Dorival tied two goals to- 
gether-vanquishing both the 
German enemy and tubercu- 
losis. (Courtesy of National 
Library of Medicine Collec- 


SUMMER 1990 

cer had gone from seventh to second 
place among the big killers in the last 
twenty-five years, although what pur- 
pose this information served for those 
who saw the poster is unclear. 
(Check List No. 56) 

Contemporary Public Health Issues: Al- 
coholism, Substance Abuse and AIDS 

While posters for certain public 
health themes, infectious disease and 
cancer, for example, continue to be 
published today, the majority of con- 
temporary posters are issues of 
greater concern to the general public, 
alcoholism, substance abuse and 
AIDS. Alcoholism has long been 
among the most important public 
health problems in society. Through- 
out the world, with the exception of 
the United States and several Euro- 
pean countries, public health cam- 
paigns attacking alcoholism and other 
health problems are the responsibili- 
ties of governments alone: In gen- 
eral, governmental educational 
efforts, including posters, bear an "of- 
ficial" stamp, stating the basic posi- 
tions and priorities in public health 
communications. This is not to imply 
that government posters are inferior 
because they are official, because 
there are some very creative, imagina- 
tively designed examples emanating 
from government groups. 

The United States is prol^ably the 
only nation in the world in which pri- 
vate initiative in public health cam- 
paigns often exceeds that of the 
government. This fact is especially 
true with alcoholism, substance abuse 

and AIDS, major current problems re- 
ceiving increasing attention from pub- 
lic health organizations. Private 
groups now make effective contribu- 
tions and, not surprisingly, a variety 
of interests is reflected in their posters. 

Anti-alcoholism education pro- 
grams have been active for some 
time, and many earlier posters on the 
subject have their origins in France, 
where the problem has been particu- 
larly severe. In the 1930s, a cam- 
paign using more than a dozen poster 
designs, presented in a straightfor- 
ward manner to stress the devastating 
effects of alcoholism on family life, 
■was published in French and Spanish. 
(Check List No. 57) The Union des 
Franyaises Centre lAlcool commis- 
sioned B. Chavannez to design three 
posters for a similar purpose; these 
posters used a more emotional appeal 
in educating the populace as to the 
pitfalls of alcoholism. (See p. 15 and 
Check List Nos. 58-59. ) Another early 
instance is the Steinlen poster for the 
Ligue Populaire Antialcoolique in 
Lyon, with a gruff bartender standing 
behind a row of glasses as the illustra- 
tion. (Check List No. 60) 

Contemporary posters from the 
United States and Europe, both from 
government agencies and private 
sources, pursue both lines of attack: 
factual, as in the French and Spanish 
series on alcoholism; and emotional, 
as in the Steinlen poster noted above. 

And for the most part, these con- 
temporary public health posters fol- 
low in the tradition of Steinlen, 
Mauzan, Raemakers and other artists 
who have provided us with 

Ach etez 

le nouveau timbre 

Calmette sauveur des tout-petits 

44. Achetez le Nouveau 
Timbre Antituberculeux. 

Albert Calmette, joint discov- 
erer of the antituberculosis 
vaccine, B.C.G., is shown on 
a 1934 French poster for 
Christmas seals. (Courtesy 
of National Library of Medi- 
cine Collection.) 


memorable graphics. Nevertheless, 
changes are apparent and posters 
today frequently differ in important as- 
pects from those published in the 
past. First, few contemporary posters 
are created by artists; most are the 
products of design studios or photog- 
raphers, presented anonymously. Sec- 
ond, there is a new boldness best 
exemplified in posters presenting in- 
fomiation on two key issues in con- 
temporary society— drug addiction and 
the still unsolved trauma brought by 

Posters dealing with daig addiction 
are relatively new phenomena, since 
the medium does not seem to have 
been employed during the earlier 
wave of public concern over addic- 
tion at the close of the nineteenth cen- 
tury. ■ In fact, it has only been since 
the 1970s that posters have appeared 
warning of the problem. A particu- 
larly .striking example of a poster on 
drug addiction, making use of the 
ubiquitous Death's head, appeared all 
over Lisbon in the summer of 1972. 

Traditionally, reticence to use popu- 
lar media to discuss addiction may 
have been due to several factors— ei- 
ther because posters were not 
deemed to be effective, or because 
agencies did not wish to call the prob- 
lem to the attention of the public, a.s- 
suming it would go away of its own 
accord. It may also have been that 
the subject of drug addiction was 
deemed too coarse for public airing. 
Today these attitudes have changed, 
and contemporary posters often are 
striking. Examples from official 
sources, such as the Department of 

Health and Social Security in Great 
Britain, now show realistic views of 
the effects of addiction, holding noth- 
ing back, similar to those developed 
by private groups in the United States. 
(See p. 16 and Check List Nos. 61-63-) 

Of course, these examples are but 
a few of many employed in cam- 
paigns against drug abuse and many 
are actually more sober in providing 
factual information. However, it is 
taie that posters which dramatize the 
sequelae of addiction are more impor- 
tant in eliciting an unforgettable emo- 
tional response than simple artistry in 
po.ster design. The nature of the prob- 
lem now puts less of a premium on 
the artist's contribution, and more on 
telling imagery. 

Posters are very much in evidence 
in the current world-wide battle 
against AIDS. Although the disease 
was first diagnosed in 1981, AIDS 
posters did not begin to appear until 
1985, and lately the number of post- 
ers published each year has been es- 
calating. In the United States, an 
industry has emerged to bring intelli- 
gence about AIDS to the general pop- 
ulation, principally to particularly 
vulnerable groups: the homeless, ho- 
mosexuals, residents of inner cities, in- 
travenous drug users and their sexual 
partners. A comparable industry ex- 
ists in other countries where govern- 
ment health agencies, and private 
as.sociations in almost all the affluent 
nations, are engaged in disseminating 
information about AIDS. 

Their messages are carried through 
radio, television, films, articles in the 
press, brochures, advertisements and 


SUMMER 1990 

48. La Course a la Mori. 

Death, a magnifying glass in 
hand, carefully observes a 
race among the leading 
causes of disease in France 
in a 1926 poster by Charles 
Jodelet. (Courtesy of Phila- 
delphia Museum of Art: The 
William H. Helfand Collec- 


posters. Posters are only one me- 
dium in communicating facts, warn- 
ings and suggestions for alternative 
behavior to elude this still incurable 
syndrome, and they are not always 
the most widely used. Often posters 
are an inefficient vehicle in reaching 
everyone and may not be the most 
cost-effective means of influencing 
special target groups. However, they 
provide a practical and rapid means 
of reaching a broad audience, and as 
such frequently form a major part of 
contemporary campaigns. An analy- 
sis of the published record of AIDS 
posters reveals a great deal about con- 
temporary attitudes of society towards 

the problems inherent in combating 
this devastating illness. It also reveals 
national and cultural differences in ap- 
proaches used to communicate meth- 
ods necessary to curtail the spread of 
AIDS. Equally interesting is the diver- 
sity of directed approaches to specific 
segments of the population. 

As a form of public communica- 
tion, posters have a major problem in 
that they are ephemeral; they are here 
today and gone tomorrow. Unlike 
books and fine prints, which tend to 
be preserved in public and private col- 
lections, posters are quickly destroyed 
by the elements if mounted outdoors, 
and quickly superseded by more 



recent information on office bulletin 
boards or hospital walls. Thus, an ad- 
mitted disadvantage of using posters 
is their poor staying power. Because 
of this, it is extremely difficult to re- 
construct material used in educational 
campaigns in past epidemics. For ex- 
ample, it is now almost impossible to 
locate examples of posters published 
as part of the 1975 swine flu cam- 
paign during Gerald Ford's administra- 
tion. Although they were ubiquitous 
at the time, very little of the numer- 
ous cartoons, brochures, posters, 
booklets, badges and other printed 
ephemera available then appears to 
have been preserved. 

To ensure the preservation of at 
least some posters, in late 1987 the 
National Library of Medicine (NLM), 
in Bethesda, Maryland, began to build 
an archive of contemporary public 
health posters from all over the 
world. Despite its brief life, the collec- 
tion now has grown to more than 
4,500 examples and new posters ar- 
rive regularly. In addition, there are 
about 200 posters on public health 
themes from earlier periods, and the 
collection is particularly strong in Rus- 
sian posters from the 1920s and the 

Without doubt AIDS, along with re- 
lated issues on the use of condoms 
and safe sex practices, is the health 
issue most broadly represented in the 
collection. There are more than a 
thousand agencies in the United 
States alone dealing with the AIDS 
problem; they include the United 
States Public Health Service, state 
health departments, civic, religious. 

gay and fraternal organizations. 
When international government and 
private agencies are added to this 
total, the number of i.ssuing bodies in- 
creases significantly. As a result, 
there are now more than 800 different 
posters from countries around the 
world in the NLM's AIDS collection, 
and there are certainly a greater num- 
ber that are not included. This poster 
archive clearly will be of value for fu- 
ture researchers studying methods 
used to sensitize public response to 
AIDS during the 1980s. 

Not surprisingly, several ideas used 
in the past for public health po,sters 
appear with only minor modification 
in AIDS campaigns, and it is interest- 
ing to note the variations artists and 
designers use in treating similar con- 
cepts. At the same time, there is a 
boldness rarely seen until the present, 
as the impact of AIDS has entered the 
public consciousness. 

The posters about AIDS stress a 
limited number of recurrent themes- 
safe sex, the use of condoms, fear of 
contracting a still deadly disease, trans- 
mission in pregnancy, avoidance of 
sharing needles and the need to be in- 
formed. Even though AIDS is largely 
transmitted sexually, women have not 
been addressed sufficiently in poster 
campaigns, undoubtedly owing to ear- 
lier assumptions that it was only gay 
men who could contract the disease. 

The AIDS posters appearing today 
generally can be divided into a num- 
ber of categories. The most common 
category presents information on the 
disease or proposes that readers seek 
out pertinent facts. For example, an 

roil 6Si :; !ii vsmsH! rm mmkm mt shiciekcy 

52. They Carry Disease from 
Filth to Food. 

Abram Games, a leading Brit- 
ish poster artist during World 
War II, designed this poster 
for servicemen to point out 
the importance of fly control. 
(Courtesy of Philadelphia l\/lu- 
seum of Art: The William H. 
Helfand Collection.) 

SUMMER 1990 

Australian poster lists five groups of 
statements: who gets AIDS, what 
AIDS is, how one gets AIDS, what 
will not lead to AIDS, and how one 
can be safe. (Check List No. 64) A 
large number of posters list similar 
facts, varying only in the amount of 
detail and in the graphic treatment of 

Factual posters such as these have 
always been a primary theme in pub- 
lic health education. A French poster, 
published by the Rockefeller Founda- 
tion which illustrates proper proce- 
dures to prevent tuberculosis, is a 
good example. (Check List No. 65) 
This poster shows, in twelve small il- 
lustrations, how tuberculosis is com- 
municated, what precautions one 
should take against infection, etc. 
Today such factual posters remain in 
the forefront in bringing educational 
messages to the public about AIDS. 

A variation on such informational 
posters stresses the risks of fatal con- 
sequences if the facts are ignored; the 
message cautions people about the in- 
sidious nature of AIDS. Creators of 
these posters either state the warning 
explicitly ("AIDS is a killer"), or they 
use striking graphic images to commu- 
nicate the same message. The combi- 
nation of information with potent 
imagery makes for more memorable 
and effective posters. 

To allay fears and misconceptions, 
another group of informational post- 
ers demonstrates what will not cause 
an AIDS infection. A recent cam- 
paign among schoolchildren in Alaska 
developed a number of useful ideas, 
among which was one poster of a 

a^! qaand 
supp zimeza - 1- on. 


Xcziveiou ClcYez 
i'ous tn^czize d 
! (Union A-j Fiancais es Contie CQCcooC 

a PARIS 28 Rue des Sainis Peres d. 2 k.r„ ^ 

magnified mosquito, with the head- 
line, "Go ahead! Spread the Word! 
You Can't Get AIDS From Alaska's 
State Bird!" (Check List No. 66) An- 
other popular poster used throughout 
the United States attempts to quell 
commonly expressed fears, illustrating 
a handshake, a doorknob, a toilet 
seat and a table setting, pointing out 
that "None of These will Give you 
AIDS." (Check List No. 67) This ap- 
proach is similar to prior campaigns 
to quiet fears by providing accurate in- 
formation as to what will and what 
will not cause cancer. Such posters 
also bear some affinity to those that 
in the past distinguished appropriate 
from inappropriate treatment. 

Finally, there are informational 
posters which propose that readers 

58. Ahf Quand Supprimera-t- 
on I'Alcool? 

As part of a program to re- 
duce alcohol consumption in 
France, B. Chavannez pub- 
lished this poster showing 
the effects of alcoholism on 
a family. (Courtesy of Na- 
tional Library of Medicine 



call or write for more complete infor- 
mation. These posters merely suggest 
the importance of obtaining informa- 
tion, without specific detail. The 
AIDS Action Committee published a 
poster with the message, "Get the An- 
swers," the illustration repeating the 
work "ask" in a variety of typefaces 
and sizes. (See p. 41 and Check List 
No. 68.) In this poster, a telephone 
number was provided for viewers to 
follow-up on the notice. Similar post- 
ers promise a booklet that will be 
sent through the mail. These efforts 
rely on striking graphics for attention 
rather than on important messages. 

One never knows, of course, 
whether compelling graphics are suffi- 
cient tools for effective communica- 
tion. To be sure, the first requirement 
of a poster is to communicate. Its ef- 
fectiveness is dependent upon initiat- 
ing a response to its message, by 
purchasing something or changing 
some pattern of behavior. Some de- 
signers are better at achieving their 
objectives to move people to action 
than others. The fact that posters con- 
tinue to be used widely in all coun- 
tries and in all cultures confirms that 
they produce positive results. 

Celebrities, including artists who 
normally might not be associated with 
so serious a problem, have been mar- 
shalled to aid in AIDS communica- 
tions. A Normal Rockwell illustration 
of a father giving the "facts of life" to 
his son, contains an added warning, 
"Don't Forget the Chapter on AIDS." 
(Check List No. 69) Popular rock 
singer Patti LaBelle appears in a 
poster published by the American 

Red Cross urging viewers, "Don't Lis- 
ten to Rumors about AIDS; Get the 
Facts." (Opposite, and Check List No. 
70.) Certainly the idea of using celeb- 
rities in posters is not new since the 
technique frequently has been em- 
ployed for earlier public health prob- 
lems. (See p. 18 and Check List No. 

Another category of AIDS posters 
relies on emotional imagery to elicit 
fear. Gravestones (or more fre- 
quently, skulls and corpses) convey 
stark warnings on the importance of 
avoiding exposure. A Mexican poster 
shows a morgue as the setting for a 
corpse; only the victim's feet are visi- 
ble, but the message is clear nonethe- 
less. The headline, "El Riesgo es de 
Todos" ("All Are at Risk") perhaps is 
superfluous. (Check List No. 72) Simi- 
larly, a poster by the Pharmacists' 
Planning Service of Sausalito (Califor- 
nia), shows a row of gravestones with 
the caption "People are Dying to 
Know." (Check List No. 73) A poster 
from PAHO, the Pan American Health 
Organization, shows an anguished fig- 
ure filling the spaces in the word 
SIDA (the French and Spanish word 
for AIDS). (Check List No. 74) The 
figure is clearly intimidated. Why he 
should be frightened and what view- 
ers should do to prevent being in the 
same state are the essential messages 
of the poster. The text demands sim- 
ply that readers get the necessary 
facts—and to the extent that the graph- 
ics are effective, it is most probable 
that they will. 

The most powerful posters calcu- 
lated to generate fear use an image of 

61. Skin Care by Heroin. 

The devastating effects of 
heroin addiction on the face 
of a young girl are shown in 
this British poster. The sub- 
text reads: "Talie heroin and 
before long you 'II start look- 
ing ill, losing weight and feel- 
ing like death. So, if you're 
offered heroin, you know 
what to say. " (Courtesy of 
National Library of Medicine 


SUMMER 1990 

a skull. For example, a Spanish lan- 
guage poster, "El SIDA," published by 
the Nipomo (California) Community 
Medical Center, contains a line draw- 
ing of a skull with a syringe in its 
mouth. (Check List No. 75) The text 
reveals what AIDS is, how one gets it, 
and what must be done to avoid it. 
Understandably, the image of Death 
does not need extensive text to con- 
vey its message. This particular 
image is reminiscent of the 
Raemaker's syphilis poster used dur- 
ing Worid War I. (See p. 3 and 
Checklist No. 7.) 

It is noteworthy that AIDS posters 
do not single out women as the cause 
of infection, in contrast to venereal 
disease posters of earlier years. In Af- 
rica, however, where heterosexual 
sex is the major route of transmission, 
there are posters warning men to 
watch out for easy sexual partners. 
One poster from Mauritius, for exam- 
ple, uses cartoons to illustrate the 
point. (See p. 20 and Checklist No. 
76.) As heterosexual transmission 
grows in importance, especially in 
inner city areas and among intrave- 
nous drug users, more posters with 
similar subjects undoubtedly will ap- 

While most posters in AIDS cam- 
paigns are designed by graphic artists, 
or anonymous design studios and 
photographers, several well-known 
artists also have developed poster im- 
ages. Of course, artists have been in- 
volved in drives to raise money for 
AIDS research and patient care, and 
there have been exhibitions of the 
work of film makers, photographers, 

painters and sculptors on AIDS sub- 
jects. With minor exceptions, how- 
ever, popular artists have not been 
commissioned to design posters for 
AIDS. Paul Davis, the artist respon- 
sible for memorable campaigns for 
the New York Public Theater, pub- 
lished a poster to raise money to ben- 
efit the East End Gay Organization in Hampton, New York, but never- 
theless, Davis' image is not related 
specifically to AIDS. (Check List No. 
77) A widely distributed poster for its 
AIDS activities was created for the Stu- 
dent Health Service of the Berkeley 
campus of the University of California 
by well-known San Francisco artist 
David Lance Goines. (See p. 21 and 
Check List No. 78.) Goines's use of 
an image of an apple and a snake 
aroused some controversy in that its 

70. Don't Listen to Rumors 
About AIDS. Get the Facts. 

A photograpti of popular 
singer Patti LaBelle is used 
to stress the importance of 
obtaining accurate informa- 
tion concerning AIDS. (Cour- 
tesy of National Library of 
Medicine Collection.) 


illustration specifically called attention 
to sexual transmission. As has been 
documented for some time, AIDS can 
be acquired by other means as well. 
Goines's design continues the tradi- 
tion of earlier posters relative to vene- 
real disease, using allegory to 
minimize attacks on the public's sensi- 
bility. It is a dignified way to handle 
an otherwise difficult subject. Still, 
Goines's approach is a minority one; 
for the most part, the imagery used in 
contemporary AIDS posters is, as with 
those for drug addiction, often ex- 
treme. In the case of AIDS portrayal, 
the problem of representation of the 
causative agent is just as perplexing 
as always, because there is no satisfac- 
tory way yet developed to illustrate 
HI'V effectively. 

In the continuing drive to reach as 
many people as possible with mes- 
sages on AIDS prevention, poster cam- 
paigns have been developed to 
appeal to specific groups. Such mar- 
ket segmentation has been an impor- 
tant technique for commercial 
products and has proven useful in the 
public health field as well. The Peo- 
ple of Color Against AIDS, an organi- 
zation in Seatde, states that "AIDS is a 
"White Man's Disease" in their series of 
posters, "Famous Last 'SX^'ords." (Check 
List No. 79) Special campaigns are di- 
rected to those who have many sex- 
ual partners; an example from the 
Seychelles urges readers to acknowl- 
edge that casual relationships are ju,st 
not worth it, or that, as a poster from 
Trinidad and Tobago, islands in the 
Caribbean, suggests, "You're Safer 
with One Partner." (Check List Nos. 

80-81) A Philippines poster directed 
to prostitutes reminds them to pro- 
vide condoms for their clients. (Check 
List No. 82) Special campaigns are di- 
rected to women of childbearing age, 
urging them to be tested before be- 
coming pregnant. While these post- 
ers have great impact, especially the 
series carrying the title, "She Has Her 
Father's Eyes and Her Mother's AIDS," 
(Check List No. 83), there remains the 
problem of reaching that group of 
women to whom the campaign is di- 
rected, and then convincing them to 
take required steps to be tested. 
These messages urge women who 
might have been exposed, or who 
might be carriers of the AIDS virus 
and who are considering pregnancy, 
to be extremely cautious. The mes- 
sages are to the point: "DON'T. You 
read about people who can carry the 
AIDS virus but show no .symptoms; 
don't take chances. Get tested before 
you become sexually involved." 
(Check List No. 84) Despite all these 
educational campaigns, however, the 
number of children born with AIDS re- 
grettably continues to grow. 

The American poster of the appeal- 
ing baby with "Her father's eyes and 
her mother's AIDS" exists in versions 
showing a black child as well as a 
white child. Similarly, posters of intra- 
venous drug users repeat the same 
copy in versions showing a black, 
white and Hispanic model. There are 
also posters of gay men— black, white 
and Hispanic— directed to specific seg- 
ments of the population. A series of 
posters published by the New Haven 
Mayor's Task Force presents telling 

71. L 'Homme le Plus Fort du 
Monde Declare .... 

French boxer Charles 
Rigoulot suggests that the 
reasons for his success in 
the ring are due to his avoid- 
ing alcohol. (Courtesy of Na- 
tional Library of Medicine 


SUMMER 1990 

photographs of men and women- 
black, white and Hispanic— in English 
and Spanish, discussing the impor- 
tance of practicing safe sex. (Check 
List No. 85) These segmented cam- 
paigns are for American audiences, of 
course, but correspondingly, posters 
published in multi-lingual countries 
such as Canada, Belgium and Switzer- 
land have similar illustrations with dif- 
ferent texts. 

Another special target has been 
prospective blood donors. Wide- 
spread anxiety erroneously exists over 
possible dangers of infection with the 
HIV viRis in donating blood, and sev- 
eral posters have been produced to 
try to allay these fears. The purpose 
of these posters is to stress safety and 
to reduce disquiet over possible con- 
tamination. (See p. 22 and Check List 
Nos. 86-87.) 

While many issues in AIDS posters 
have antecedents, there are several 
using completely new ideas. The seri- 
ousness and pervasiveness of the 
AIDS crisis has necessitated discussing 
subjects openly in ways that never 
would have been tolerated in the 
past. The use of condoms and the 
vital importance of safe sex practices 
are categories of novel posters that, in 
fact, are among the most forceful ever 
developed. The intent of many of the 
condom themes has been to make 
their use a de-mystifying everyday 
event, worthy of no special attention. 
For example, one Swiss postal cam- 
paign blends romance with condoms, 
using one as a substitute for the full 
moon, in settings over easily identifi- 
able places- Hawaii, Paris, Rome, Rio 

and London. (Check List No. 88) The 
agency preparing these posters has 
made them in several sizes, the larg- 
est for outdoor billboards, and the 
smallest prepared as stickers to be af- 
fixed to envelopes. Three Icelandic 
posters show ordinary citizens using a 
condom in unorthodox ways, playing 
with one, stretching one, blowing one 
up, using one as a head covering, etc. 
(Check List No. 89) Equally notewor- 
thy in this bold new approach is the 
fact that the photographs of the men 
and women used as models in these 
posters also carry their signatures. 
The message is definitely clear from 
such posters: Condoms wUl "Stop 
AIDS." The popularization of con- 
doms has even spawned National 
Condom Week, as a poster published 
by the Pharmacist's Planning Service 
of Sausalito (California) testifies. 
(Check List No. 90) 

The series "Famous Last Words," 
distributed by People of Color Against 
AIDS, also includes one, "I Don't 
Need to Wear One of Those," stress- 
ing the necessity of using condoms. 
(Check List No. 91) In the same vein, 
a British poster widely used in air- 
ports and bus terminals shows a con- 
dom with the headline, "Life 
Insurance for 15p." (Check List No. 
92) From a distance, unfortunately, it 
is not possible to know what is being 
sold, and only close inspection re- 
veals that the object in question is a 
condom. Hence, the subtlety of the 
poster may well be lost on many. On 
the other hand, a couple embracing 
over the headline, "Don't Die of Em- 
barrassment; AIDS is a Killer. Use a 




76. LeSIDA. Evitezles 
Parinaires Faciles. 

A poster from Mauritius, remi- 
niscent of posters used dur- 
ing World War I and World 
War II, warns that easy 
women may be transmitters 
of AIDS. (Courtesy of Na- 
tional Library of Medicine 

CoUoge d«» OndM BMufl 

Condom," seems better at holding the 
attention of the viewer. (Check List 
No. 93) As is the case with commer- 
cial advertising, it is only the bal- 
anced blend of text and image that 
can provide an effective result. 

Caricatures and comic strips also 
have been used to enhance the accep- 
tance of condoms. The Ministry of 
Health of Australia has developed 
comic strip posters to stress the need 
for condoms in campaigns directed to 
the Aboriginal community. Organiz- 
ers of this Australian campaign even 
have developed a poster with a new 
hero— Condoman, who suggests that 
the viewer "Use Frenchies." (See p. 24 
and Check List No. 94. ) In one poster 

with the admonishment, "You Don't 
Have to be a Queenie to Get AIDS," a 
man has sex with someone who has 
AIDS. (See p. 26 and Check List No. 
95.) He goes back to his wife. She 
gets sick; she gets AIDS. Quickly, ev- 
erybody gets sick and dies. As 
noted earlier, the comic strip tech- 
nique is an easy method of attracting 
attention. Its usefulness was proven 
in venereal disease campaigns in 
World War II, in which blown up im- 
ages of brief episodes stressed the 
need to avoid prostitutes or pay quick 
visits to the pro station. (Check List 
Nos. 21-22) 

Of course, posters used by Ameri- 
can officials in World War II did 


SUMMER 1990 

occasionally discuss the importance 
of prophylaxis, but they never were 
so bold as to mention the word con- 
doms. The posters in the series by Ar- 
thur Szyk (Check List Nos. 23-24), for 
example, suggested that failure to use 
prophylactic measures was an aid to 
the enemy, and another poster carried 
the headline, "Sex Exposure Without 
Prophylaxis is an Aid to the Axis," but 
condoms neither were pictured nor 
mentioned. (See p. 31 and Check List 
No. 96.) 

Gay groups also have emphasized 
the importance of using condoms in 
the practice of safe sex. The Gay 
Men's Health Crisis in New York has 
distributed an effective drawing, with 
text in both English and Spanish, not- 
ing that "A Rubber is a Friend in Your 
Pocket." (See p. 32 and Check List 
No. 97.) A Swiss poster shows con- 
doms along with a watch band, a 
necktie and other masculine apparel, 
implying that this is the new intimate 
line for men. (Check List No. 98) In 
another poignant poster, a large pho- 
tograph of a condom has only the 
briefest text, in letters much smaller 
than the photograph, "Help Prevent 
Despair. Care." (Check List No. 99) 
HERO, a Baltimore group, has issued 
posters of gay men— black, white and 
Hispanic— with the provocative head- 
line, "You Won't Believe What We 
Like to Wear in Bed." (Check List No. 

Expanding on the importance of 
condoms, a related category includes 
those posters discussing safe sex in its 
various aspects. Again, many of the 
posters on this theme have been is- 


E N T I O N 

sued by gay groups. Two representa- 
tive images by Bruce Rapp were pub- 
lished by The CORE Program, a 
group based in Los Angeles, with 
copy reading, "Safe Sex. Are You 
Man Enough?" (See p. 33 and Check 
List Nos. 101-102.) Another poster dis- 
plays the muscular torso of a man 
with the copy, "No Less a Man for 
Playing Safe." (Check List No. 103) In 
their attempts to gain attention, de- 
signers of some posters directed to 
the gay community are extremely 
frank in discussing sexual practices. 
Eor example, a poster by the Colo- 
rado AIDS Project promises that "Our 
Workshop is Positively Erotic," and an- 
other from the Tucson AIDS Project, 
parodying a title from a Paul Simon 
song, suggests that "There Must be 50 

78. AIDS Prevention. 

California poster artist David 
Lance Goines developed 
this poster, showing a snake 
wound around an apple on a 
tree, to support the Berkeley 
Student Health Service. (Re- 
produced with permission of 
the artist. Courtesy of Na- 
tional Library of Medicine 


Ways to Please a Lover," illustrating 
sixteen of them. (Check List Nos. 104- 
105) A large poster for the Colorado 
AIDS project, cleverly designed to be 
used either as one or as six individual 
smaller posters, proposes methods of 
practicing safe sex with the titles 
"Taste, Watch, Touch, Excite, Explore, 
Imagine," with appropriate illustra- 
tions and provocative texts for each. 
(Check List No. 106) 

A critical AIDS campaign is di- 
rected to IV daig users. The problem 
of reaching this group to stop so 
deadly a practice is not an easy one 
to solve. A crudely drawn poster 
from the Brooklyn AIDS Task Force 
admonishes, "Hey Man — No Sharing." 
(See p. 42 and Check List No. 107.) 
Both Swiss and American posters 
have appeared with large syringes 
and needles as the illustration, with 
brief texts urging readers, "Don't Pass 
It On." (See p. 34 and Check List Nos. 
108-109.) Other posters, especially 
those published by the British Depart- 
ment of Health and Social Security, 
are more striking and bold. One with 
the headline "Heads You Live, Tails 
You Get AIDS," and another stating 
"If You Get into Injecting, What's 
Going to Get into You?", are represen- 
tative. (Check List Nos. 110-111) 
These daring visual images do get the 
attention of viewers, but the problem 
is to make those practicing the vi- 
cious habit of intravenous drug usage 
and the sharing of unclean needles to 
notice the poster in the first place. 
Even the most shocking illustration 
cannot guarantee that members of 
this hard-to-reach group will notice. 

since they may be completely resis- 
tant to any message at all. A dramatic 
poster in this category is a billboard- 
sized advertisement issued by the U.S. 
Public Health Service showing a skele- 
tal hand, with the legend, "Sharing 
Needles is Just Asking For It." (Check 
List No. 112) 

A final theme in AIDS education ef- 
forts, and a relatively recent addition, 
urges compassion for the patient with 
AIDS. Posters from the United States 
and from Gennany make exactly the 
same point: "Don't Give AIDS a 
Chance, " and don't leave the patient 
with AIDS to suffer alone. (See p. 35 
and Check List Nos. 113-114.) One of 
the stronge-st and most appealing ex- 
amples in this group is that of a child: 
"I Have AIDS; Please Hug Me. I Can't 
Make You Sick." (See p. 36 and 
Check List No. 115) 

Unfortunately, the NLM collection 
does not permit any generalization 
about changes in content over time. 
Few of the posters against AIDS are 
dated, and few have the names of the 
artists and design studios who pre- 
pared them. Certain trends are clear, 
however. In the United States now, a 
greater effort is being directed to- 
wards minority groups, to the home- 
less, and to intravenous daig users. 
Greater efforts are being expended to 
reach those living in slum areas of 
large cities. In Europe also, there is a 
noticeable drive to address a broader 
segment of the population, but not to 
the extent that it has in this country. 
Third World efforts are still not as 
hard-hitting and bold as they are 


86. Doar Sangue e urn Ato 
de Amor. 

The Pan American Health Or- 
ganization published this 
poster in both Spanish and 
Portuguese to ally fears over 
possible AIDS contamination 
in blood donation programs. 
(Courtesy of National Library 
of Medicine Collection.) 


SUMMER 1990 

elsewhere, even though for their pop- 
ulace the problem is growing rapidly. 

Despite the variety of appeals in 
the posters on AIDS, there is one con- 
cept which might have been expected 
and which does not seem to have sur- 
faced as yet. None of the AIDS post- 
ers in the sample of 800 in this 
analysis shows a patient with AIDS. 
Why should this be the case? Are con- 
siderations of privacy and public sen- 
sibility sufficient to overcome the 
need to show the ravaging effects of 
the disease? Would the appearance 
of an AIDS patient be an effective 
means of getting attention, or would 
it so offend viewers as to negate any 
interest in obtaining further informa- 
tion? Patients with AIDS have been 
the subject of photographs by leading 
artists, most notably Nicholas Nixon, 
but the purpose of these photographs 
differs from that of the poster. Never- 
theless, new posters keep appearing, 
and their number will continue to 
grow as long as the AIDS problem re- 
mains. For this reason, it seems logi- 
cal that posters, including illustrations 
of AIDS patients, might well be in- 
cluded as time goes on. In any 
event, the existing large group of post- 
ers is clearly representative of the ex- 
tensive educational efforts worldwide 
that have been mounted to direct at- 
tention to the catastrophic effects of 
AIDS. The archive of AIDS posters 
that the NLM is building can be only 
expected to grow in importance in 
the future. 


Posters have been a powerful force 
in shaping public opinion because 
propagandists have long known that 
visual impressions are extremely im- 
portant in memory retention. Al- 
though people may forget a 
newspaper article, most remember a 
picture. A pamphlet or a newspaper 
can be thrown away, unread; the 
radio or television turned off; films or 
political meetings not attended. At 
some time or other, however, every- 
c:)ne notices messages when walking 
or driving, or sees posters on bulletin 
boards in offices, hospitals, clinics or 
pharmacies. The main objective of 
posters, as with other communica- 
tions media, is to influence attitudes, 
to sell a product or service or change 
behavior patterns. Public health post- 
ers are clearly in the third category, 
their purpose being to alter the con- 
sciousness of the public so as to bring 
about an improvement in health prac- 
tices. In presenting their appeals, 
poster designers frequently have been 
able to achieve an artistically worthy 
result, but their overall success must 
be measured more by effectiveness in 
convincing viewers of their messages. 
Continued publication of posters to 
convince and motivate the public defi- 
nitely points to positive con,se- 
quences. Thus, posters continue to 
be used as much as ever, their de- 
signs evolving to reflect contemporary 
sensibilities and the needs of society 
as a whole. 




1. Maurice Rickards, We Public 
Notice (Ne'^' "^'ork: Clarkson N. Potter, 
Inc., 1973), 43. 

2. John Gross, "Plague Years in the 
Imagery of Those Who Endured Them," 
We New York T/wes, January 31, 1988. 
Section 2, 35. 

3. Maurice Rickards, Posters of the Fi>~st 
World War (London: Evelyn, Adams and 
Mackay, 1968). 

4. W.H. Helfand, "The Poisoning of 
the Sick at Jaffa," Veroffentlichioigen der 
Intemationalen Gesellscbaft fur 
Geschichte der Phartnazie E.V.. Band 42 

5. Allan M. Brandt, No Magic Bullet 
(New York: Oxford University Press, 
1985), 52. 

6. A pro station or prophylactic station 
was the place to which a serviceman 
went after a sexual encounter. 

7. Brandt, No Magic Bullet, 101. 

8. For illustrations of various methods 
by which cholera has been depicted, see 
P. Bourdelais, and A. Dodin, Visages du 
Cholera (Paris: Editions Belin, 1987). 

9. Nancy Tomes, "The Rockefeller 
Commission for the Prevention of Tuber- 
culosis in France: A Comparative Perspec- 
tive on American Health Reform," unpub- 
lished manuscript, 1989. 

10. Abram Games, "Art for the Cause of 
Victory: My World War II Posters," PS. 
(Quarterly Journal of the Poster Society), 1 

11. Anthony Rhodes, Propaganda. The 
Art of Persuasion: World War II (New 
York: Chelsea House Publishers, 1976), 


12. David F. Musto, We American Dis- 
ease, (New Ha\'en: '^'ale University Press, 

13. Christopher S. Hall, ed., AIDS Life- 
line: AIDS Educational Seirice Organiza- 
tions {Washinglon, D.C.: National AIDS 
Netu'ork, 1988). 

14. Paula A. Treichler, "AIDS, Gender 
and Biomedical Discourse: Current Con- 
tests for Meaning," in Elizabeth Fee and 
Daniel M. Fox, eds., AIDS, The Burdens of 
History; (Berkeley: University of California 
Press, 1988), 190-266. 

15. William H. Helfand, "The Pharma- 
ceutical Poster." Pharmacy in History 15 

16. Michael Kimelman, "Bitter Harvest: 
AIDS and the Arts," The New York Times, 
Section 2, March 119, 1989, 1. 


• >^:-*:.^f--i;=^^v ...1 

94. Condoman Says: Use 

A newly-created comic hero, 
Condoman, proclaims the ab- 
solute need to use condoms 
as a means of preventing 
AIDS infection. (Courtesy of 
National Library of l\/ledicine 


Geux qui ! 
atteints sans le 

La Syphilis des 
pappnts est une 
des ppincipcles 
causes de mala 
dici ct de mont 
des nouveaux - 
nes et des enFants 

' , TJrv 



d affections 


sont doplgi- 

ne 3yphilitique 

La Syphilis 

est une moladie 

gpave mais heupeu- 

sement guepissable 

Pour tout 5YPHILITI0UE c'estun devoir dese 
Soigneretdeviterde transmettre son mal. 

-Ligue Nationale Fndnyaise 
oontpe Ic pcpil Venepicn 

Daoonnut dVtilite Publiitue pir dicrit 
da 25 Soil 191$ . (t.Su, A Uiboimi . PASIl 

imfUmm- LiKm.pimii 

Vu : Lb MinistrB du Travail, it THygiene 
-de TAssistance et de la Prevoyance 
50ciale5 - — 

8. La Syphilis Est un Fleau So- 
cial. Ses Victimes Sont In- 

The French artist, Theodoro, 
used the frightening image of a 
man and woman l<issing be- 
neath a grinning skull to illus- 
trate the seriousness of 
possible syphilis infection. 
(Courtesy of Philadelphia Mu- 
seum of Art: The William H. 
Helfand collection.) 


36. Italiani, Aiutate la Croce 
Rossa Nell'Assistenza ai 

In this Italian poster by 
Basilio Cascella, a Red 
Cross nurse uses a small 
dagger to attack the monster 
of tuberculosis, here circling 
the globe. (Courtesy of Phila- 
delphia Museum of Art: The 
William H. Helfand Collec- 



37. Con Queste Armi 
Vinciamo Tuberculosi. 

An Italian poster by T. 
Corbella, published around 
1920, stiowing the methods- 
sun, air, rest, etc. that will 
conquer tuberculosis. (Cour- 
tesy of Philadelphia Museum 
of Art: The William H. 
Helfand Collection.) 


38. Ecrasez la Tuberculose 
et Sauvez I'Enfance. 

A poster by Lionetto 
Cappiello published as part 
of the anti-tuberculosis cam- 
paign carried out in France 
by the Rockefeller Founda- 
tion during the years after 
World War I. (Courtesy of 
Philadelphia Museum of Art: 
The William H. Helfand Col- 



Red Cross Christmas Seal =j= 


42. The Next to Go. Fight 

Posters have been used con- 
tinually throughout the world 
to support annual Christmas 
seal campaigns. This exam- 
ple of the man pushing a 
symbol of tuberculosis out of 
the room was published in 
the 1920s. (Courtesy of The 
William H. Helfand Collection.) 



49. Guerra Alia Mosche! 

Flies, shown as airplanes, 
drop bombs on a crowd of 
people in an Italian poster, 
c. 1910, designed to stress 
the importance of sanitation 
in the prevention of infection. 
(Courtesy of Philadelphia Mu- 
seum of Art: The William H. 
Helfand Collection.) 


Checklist of Posters Cited 

1. PEST PEST, Anonymous, Germany, 
1683- Ars Medica (Philadelphia Museum 
of Art) Collection. A quarantine sign, 
showing two crosses over the words of 
the title. 

2. SIFLIS, by Ramon Casas, Spain, 
1900. Ars Medica (Philadelphia Museum 
of Art) Collection. A pretty woman wear- 
ing a long, fringed cape, holds a flower, 
as a snake climbs up her back. The text 
advertises a sanitarium for the cure of 
syphilis; it reads "Sifilis. Curacion 
Absoluta y Radical en el Sanatario Para 
Sifiliticos . . . ." See Marilyn McCully, Els 
Qiiatre Gats; Art in Barcelona Around 
1900. Exhibition Catalog (Princeton: 
Princeton U. Press, 1978), No. 14. 

3. FETE PARISIENNE, Anonymous, 
France, 1902. Ars Medica (Philadelphia 
Museum of Art) Collection. A poster ad- 
vertising a series of Parisian events for the 
benefit of cholera victims. The illustration 
shows four figures-in the foreground, a 
woman is kneeling on a broad pedestal 
and bending over to hold a young chol- 
era victim in her arms. In the rear is a 
torso of an angel and a woman looking to- 
ward heaven. See W. H. Helfand, Medi- 
cine & Pharmacy: 100 Years of Poster Art 
(Albany, 1981), No. 25. 

C.W. Reed, U.S.A., 1896. Helfand (New 
York) Collection. A poster showing an 
Angel, designed for a fund-raising event. 

Henri Rapin, France, 1923. NLM, Ars Med- 
ica (Philadelphia Museum of Art) Collec- 
tions. A poster to raise money for 
research at the Institut Pasteur. The 
poster shows various illustrations of Pas- 
teur designed by several artists, and the 

public is urged by the text to purchase 
these images. Exhibited in "In Time Of 
Plague," American Museum of Natural His- 
tory, New York, 1987. 

SUR TO! . . ., by Theophile-Alexandre 
Steinlen, France, 1916. Ars Medica (Phila- 
delphia Museum of Art) Collection. The 
text is written on a tombstone, and pres- 
ents a dramatic appeal to French soldiers 
to keep strong for their country, and to re- 
sist those seductions in the street which 
risk exposure to an illness as "dangerous 
as war" leading to a "useless death with- 
out honor." The symbols are a woman 
embracing a soldier, a sick soldier in a 
hospital, a skull and crossbones, etc. 

Louis Raemakers, Belgium, c. 1916. Ars 
Medica (Philadelphia Museum of Art); U. 
of Wisconsin Medical School Library Col- 
lections. A woman with spider-like hair, 
wearing a black cloak, stands among 
rows of graves. She holds a skull in her 
hands in this powerful illustration of the 
evils of syphilis. See D. Dooijes, & P. 
Brattinga, A History of the Dutch Poster, 
iS90-i9(J0 (Amsterdam, 1968). no. 131. 

BRABLES, by Theodoro, France, c. 1930. 
Ars Medica (Philadelphia Museum of Art) 
Collection. A man and woman kiss; be- 
hind them is a grinning skull. A lengthy 
text appears below the illustration, and a 
line at the bottom warns that each victim 
must be cured and avoid transmitting the 
disease to others. Exhibited in "In Time 
of Plague," American Museum of Natural 
History, New York, 1987. 



95. You Don 't Ha ve to be a 
Queenie to Get AIDS. 

An Australian drive to reach 
people in the Aboriginal com- 
munity with messages about 
AIDS used a comic strip to 
tell a simple story on the 
deadly nature of the disease. 
(Courtesy of National Library 
of Medicine Collection.) 


CORTEJO NUPCIAL, by Lucien Achille 
Mauzan. France, c. 1905. Helfand (New 
York) Collection. A bride and bride- 
groom are attended by l^vo figures of 
death, one labeled "Blenorragia" and the 
other "Sifilis". Spanish text, the poster 
probably intended for use in Argentina. 

ING MY WA\?, by Reginald Mount. En- 
gland, c. 19-t3 The illustration is of a 
skull, with an orchid for a hat. Below the 
title and illustration is a lengthy text warn- 
ing of the 'easy' girl friend. See Anthony 
Rhodes, Propaganda (New York, 1976), 

p. 129; Anon., Paper Bullets: Great Propa- 
ganda Posteis, Axis & Allied Countries. 
World WarllCNew York, 1977), No. 7. 

11. JUKE JOINT SNIPER, by Ferree, 
U.S.A., c. 1942. NLM Collection. A prosti- 
tute stands in front of a dance hall, light- 

ing a cigarette. The title is on the top and 
at the bottom "Syphilis and Gonorrhea." 

12. EASY TO GET, by Charles Casa, 
U.S.A., c. 1943. NLM Collection. The illus- 
tration is of a prostitute leaning against a 
brick wall. The text is brief: "Easy to get. 
Syphilis and Gonorrhea." 

Anonymous, U.S.A., c. 1944. NLM Collec- 
tion. The illustration is of a pretty 
woman, with three service-men walking 
by. The text continues, "Pick-ups, 'Good 
Time' Girls, Prostitutes Spread Syphilis 
and Gonorrhea." See A. Brandt, No Magic 
Bullet (New York, 1985), after p. 164. 

14. V D DON'T GAMBLE, Anony- 
mous, U.S.A., c. 1944. Museum of Mod- 
ern Art (New York) Collection. A pair of 
dice, one labeled "V" and the other "D," 
Published by U.S.N. Bureau of Naval Per- 
sonnel Training Aids, No. VD-11. 


SUMMER 1990 

15. V E, V J, V D, by Robert Bode, 
U.S.A., 1945. NLM Collection. Three 
parts, the top two showing smiling sailors 
with the captions "V E" and "V J", but a 
frowning sailor in the bottom portion with 
"V D." 

16. STAMP OUT V D, Anonymous, 
U.S.A., c. 1943. NLM Collection. The illus- 
tration shows a foot about to walk on the 
letters "V D". At the bottom of the poster 
the words "Venereal Disease" spell it out 
even more clearly. 

Robert Bode, U.S.A., 1945. NLM Collec- 
tion. The illustration is of a sailor; there is 
no text other than the title. See A. 
Brandt, No Magic Bullet (New York, 
1985), after p. 164. 

PRO STATION, by Robert Bode, U.S.A., 
1944. NLM Collection. A sailor wearing a 
dunce cap writes the title on a blackboard 
over and over again. Published by Bu- 
reau of Medicine & Surgery, U.S. Navy, 

TO REMEMBER?, by Woodcock, U.S.A., 
1944. NLM, Landauer Collections. A for- 
lorn looking sailor asks himself the ques- 
tion of the title as he approaches a Pro 
Station. Published by Bureau of Medicine 
& Surgery, U.S. Navy, VT-8. 

SAILOR?, by Robert Bode, U.S.A., 1945. 
NLM Collection. A sailor, carrying a duf- 
fle-bag walks in the direction of a sign la- 
beled "To Trains." There is no text other 
than the title. Published by NavMed 893, 
Bureau of Medicine & Surgery, LI.S. Navy, 

21. PLEASE BE CAREFUL, by Wood- 
cock, U.S.A., 1944. NLM Collection. A 
comic strip, in nine sections, warning sail- 
ors to use care and prevent infection from 

venereal disease. Published by Bureau of 
Medicine & Surgery, U.S. Navy, VP-7. 

22. THERE'S NO PLACE . . ., by Rob- 
ert Bode, U.S.A., 1944. NLM Collection. 

A comic strip in 12 parts pointing out that 
avoiding women in all countries, includ- 
ing the U.S.A., is essential. 

LAXIS, by Arthur Szyk, U.S.A., 1942. Mus- 
solini, Tojo and Hitler are shown, the 
latter two holding syringes. At the bottom 
"Prophylaxis Prevents Venereal Disease" 
and the note that the publisher is John 
Wyeth & Brother, Inc., Philadelphia. 

Szyk, U.S.A., 1942. Hitler, walking with 
Mussolini and Tojo, notes that "But—Pro- 
phylaxis Prevents Disease," as an answer 
to the comment from Tojo that "American 
soldier could catch it with ease." The 
poster was published by John Wyeth and 
Brother, Philadelphia. 

LINES, Anonymous, U.S.A., 1943. A mos- 
quito can be seen against the background 
of a full moon; it is observed by a soldier 
holding a tommy-gun. The text notes 
after the title. "The malaria Mosquito is 
more Deadly than the Enemy." 

RHEA, by Karsakov, U.S.A., 1944. NLM 
Collection. A man, made up of newspa- 
per clippings, including quack advertise- 
ments, headlines, etc. pours a dose of 
medicine on a spoon. The text, at the bot- 
tom of the poster, continues "See your 
doctor or health officer." Published by 
U.S. Public Health Service. 

Anonymous, U.S.A., c. 1943. NLM Collec- 
tion. A sick patient is crossed out at the 
top of the poster, and a healthy worker is 
shown as the major illustration. The text 
continues after the title "Quickly, Cheaply, 



Painlessly with New Drugs. See Your 
Doctor or Health Officer." 

LIS AND GONORRHEA, by Karsakov, 
U.S.A., c. 1935. Museum of Modern Art 
(New York) Collection. The illustration is 
a small woman behind whom is a lengthy 
shadow. Tliere is no additional text. Pub- 
lished by U.S. Public Health Service, No. 

SYPHILIS, Anonymous, France, c. 1918. 
Helfand (New York) Collection. A shield 
is used to fend off a mask on the top of 
which is the label "Syphilis." The poster 
was published by the Ministre de 

Karsakov, U.S.A., 1944. NLM, Museum of 
Modern Art (New York) Collections. A 
drawing of a man with a tourniquet on 
his arm is the background for the text. 
Published by U.S. Public Health Service, 
N. 13. 

Leo Fontan, France, c. 1935. Helfand 
(New York), Institut Fournier (Paris) Col- 
lection. The illustration is divided into 
r^o parts, one showing a physician giving 
an injection and the other a healthy fam- 
ily. The text is extensive, with guidance 
on what to do and where to go listed on 
each side, top and bottom of the illu.stra- 

DISEASES, by H.M. Bateman, England, c. 
1940. Helfand (New York) Collection. A 
woman sneezes inside a draper's shop, 
causing others present to react with sur- 
prise. The text is similar to three others 
in this series. 

mous, England, c. 1930. Helfand (New 
York) Collection. The illustration is of a 
smiling baby. At the bottom of the 

poster, the text reads "Immunisation pro- 
tects. Ask at your Local Council Offices 
or Welfare Centre." 

mous, Belgium, 1923. Helfand (New 
York) Collection. The illustration shows a 
hairy hand attacking the throat of a fright- 
ened child in this poster warning of the 
necessity to immunize against diphtheria. 

Bayer, U.S.A., 1949. Museum of Modern 
Art (New York) Collection. A hand holds 
a test tube. At the bottom of the poster, 
the text notes the organization publishing 
it, "National Foundation for Infantile Paral- 
ysis, Inc." 

TUBERCOLOSI, by Basilio Cascella, Italy, 
c. 1920. Ars Medica (Philadelphia Mu- 
.seum of Art) Collection. A Red Cross 
nurse uses a daggar to attack a monster 
crawling on a globe. Exhibited in "In 
Time of Plague," American Museum of 
Natural History, New York, 1987. 

TUBERCULOSI, by T. Corbella, Italy, c. 
1920. Ars Medica (Philadelphia Museum 
of Art) Collection. Swords bearing meth- 
ods to combat tuberculosis attack a 
hooded death figure. The measures, 
cleanliness, sun, air, rest, proper food, 
hygiene and perseverence assure 

that ' . . . . with these arms we shall con- 
quer tuberculosis." Exhibited in "In Time 
of Plague," American Museum of Natural 
History, New York, 1987. 

Cappiello, France, c. 1925. Ars Medica 
(Philadelphia Museum of Art) Collection. 
A woman holds her child above her as 
she steps on a serpent. Other than the 
title, there is no additional text. 

SUMMER 1990 

LA SANTE, by Louis Raemakers, Belgium, 
c. 1920. Rockefeller Archive Collection. 
A nurse stands near a man resting in bed. 

by George Dorival, France, 1917. NLM, 
Rockefeller Archive Collections. A sword 
has pierced the German eagle. At the top 
is "2 Fleaux — Le Boche la Tuberculose." 

guste Leroux, France, c. 1917. Rockefeller 
Archive Collection. A nurse carrying a 
child. The text continues, ". . . et des 
oeuvres sociales dans la croisade contre la 
tuberculose et la mortalite infantile. 
Soutenez-La!" See A.C. Lelieur, ed.. La 
Femme dans la Realite Qiiotidienne. 
Affiches 1890. 1930. (Paris: Societe des 
Amis de la Bibliotheque Forney, 1979), 
No. 18. 

BERCULOSIS, Anonymous, U.S.A., c. 
1925. Helfand (New York), Institute of 
the History of Medicine, Johns Hopkins 
University (Baltimore) Collections. A 
poster for the Red Cross Tuberculosis seal 
campaign. As a Red Cross nurse, a 
woman and a child watch, a man pushes 
a spectre, symbolizing tuberculosis, out 
the door. 

TUBERCULEUX, by Wilquin, France, 

c. 1942. Helfand (New York) Collection. 
A boy with his arms raised stands before 
a school in front of which are children ex- 
ercising and swimming. The text reads 
"Sauvez la Jeunesse. Achetez le Timbre 
Antituberculeux," and at the bottom "La 
Tuberculose est Evitable." 

France, 1934. NLM Collection. The illus- 
tration is of an enlarged stamp issued 

with Calmette's portrait, under which is 
written "Calmette Sauveur des Tout-Petits." 

TUBERCULEUX, by Lucien Levy-Dhurmer, 
France, c. 1920. Ars Medica (Philadelphia 
Museum of Art) Collection. A fund-rais- 
ing poster for tuberculosis victims of 
Worid War 1. A soldier holding a walking 
stick looks out on an impressionistic sea. 
A blo.ssoming tree fills the sky and a vil- 
lage can be seen in the distance. See W. 
H. Helfand, Medicine & Pharmacy: 100 
Yea)s of Poster Art i kVonny , 1981), No. 32. 

TUBERCULEUX, by Abel Faivre, France, c. 
1918. Ars Medica (Philadelphia Museum 
of Art) Collection. One of a series of post- 
ers designed to raise funds for tuberculo- 
sis victims of the First World War. A 
soldier looking towards the sky is aided 
by a nurse, whose hands are on his shoul- 
ders. At the bottom "Sauvons-les." See 
W. H. Helfand, Medicine & Pharmacy: 
100 Years of Poster Art (A\bany, 1981), 
No. 31. 

by Roll, France, c. 1920. Helfand (New 
York), Library of Congress Collections. A 
poster issued by the Comite Central 
d'Assistance aux Militaires Tuberculeux, 
showing an invalid resting on a chair, its 
back raised and his feet elevated; he is at- 
tended by a nurse. 

Charles Jodalet, France, 1926. Ars Medica 
(Philadelphia Museum of Art) Collection. 
A poster issued by the general commis- 
sion for propaganda of the National Of- 
fice of Social Hygeine as part of the 
campaign of the National French League 
against Venereal Disease. The macabre 
scene shows death looking through a 
magnifying glass at three horses running a 
race. The winner is Tuberculosis, closely 
followed by Syphilis, while Cancer is a dis- 
tant third. The text further notes that 


tuberculosis kills 150,000 French citizens 
per year and that syphilis kills 140,000. 
Cancer, it is noted, shows only 40,000. 
See W. H. Helfand, Medicine & Phar- 
macy: 100 Years of Poster Art, (Albany, 
1981), No. 11. 

Anonymous, Italy, c, 1910. Ars Medica 
(Philadelphia Museum of Art) Collection. 
A procession of flies, as airplanes, the first 
one holding a bomb labeled "Microbi" 
which it drops on a crowd of people. A 
second bomb is falling; it is labeled 
"Germi della Tisi," and a third, "Malatie" is 
breaking up. Exhibited in "In Time of 
Plague," American Museum of Natural 
History, N.Y., 1987. 

Anonymous, England, 1943. Ars Medica 
(Philadelphia Museum of Art) Collection. 
A large mosquito with a swastika on its 
tail dives towards the bottom of the 
poster. The text reads "Take treatment, 
Cover arms & legs. Against bites after 
dusk. Attack all mosquitos." 

51. I'M LOOKING FOR YOU, by Abram 
Games, England, c. 1943- Ars Medica 
(Philadelphia Museum of Art) Collection. 

A large fly is superimposed on a face; the 
wings of the insect are the eyes of the 
face, and they are labeled "Fever" and 
"Malaria." At the bottom the text reads 
"Protect Yourself Against Mosquitos. You 
Owe it to Yourself- Your Comrades-Your 

FILTH TO FOOD, by Abram Games, En- 
gland, c. 1942. Ars Medica (Philadelphia 
Museum of Art) Collection. Flies, includ- 
ing one huge example, are at the top of 
the poster and a plate of food beneath 
them. The headline "Kill all Flies" ap- 
pears after the title, and at the bottom 
"You Owe it to Yourself— Your Comrades- 
Your Efficiency." 

Fellnagel, U.S.A., c. 1940. Museum of 
Modem Art (New York) Collection. A sci- 
entist uses a pointer to point to two large 
abstract figures of a man and woman. On 
the side is a list of five points to look for, 
"lumps in breast, irregular bleeding, etc." 
Published by U.S. Public Health Service, 
No. 4. 

YEAR, by Fellnagel, U.S.A., c. 1935. Mu- 
seum of Modem Art (New York) Collec- 
tion. A photograph of a crowd of men in 
an outline of a tree, with an abnormal 
growth coming out of the trunk. Pub- 
lished by U.S. Public Health Service, No. 1. 

CANCER, Anonymous, U.S.A., c. 1940. 
Museum of Modern Art (New York) Col- 
lection. The illustration shows the head 
of a worried woman holding a teaspoon 
to her mouth. The full text reads "No 
home remedy, no tonic, no special diet, 
no salves, no powders, no pills ever 
cured, only surgery, x-ray or radium can 
cure cancer." Published by American Can- 
cer Society. 

PLACE, by Fellnagel, U.S.A., c. 1940. Mu- 
seum of Modern Art (New York) Collec- 
tion. An arrow, signifying increase, is 
shown superimposed on an outline of a 
man. The text reads "Cancer 7th to 2nd 
place among the big killers— in last 25 
years." Published by LI.S. Public Health 
Service, No. 2. 

57. ALCOHOLISMO NO. 424A. Anony- 
mous, France, c. 1910. Julien (Paris) collec- 
tion. Three scenes of the effect of 
alcoholism on soldiers, a victim being 
tried by a military court, etc. Spanish text. 

L ALCOOL?, by Chavennez, France, c. 
1920. NLM Collection. A woman and her 
two children admonish a man sitting at a 


SUMMER 1990 

table with a bottle of wine in iiis hand. 
Published by the Union des Frangaises 
Contre L'Alcool. See Alain Weill, ed., 
L 'Affiche en Occident de ces Origines a 
nos Jours (Paris & Kyoto, 1978), No. 37. 

L'ALCOOL?, by Chavennez, France, c. 
1920. NLM Collection. A soldier watches 
a drunken man standing at a street light. 
Published by the Union des Francaises 
Contre L'Alcool. 

ALCOOLIQUE, by Theophile-Ale.xandre 
Steinlen, Belgium, 1920. A bartender 
stands behind a .shelf of glasses, his hands 
on a pitcher. There is a lengthy text 
below the illustration. The illustration is 
the same as one on the cover of L'Assiette 
au Beurre, 11 July, 1901. See R. Bagniel. 
& C. Zagrodski, Steinlen Afflchisle iPims, 
1986), No. 75. 

mous, Great Britain, 1986. NLM Collec- 
tion. A photograph of the face of a 
young girl, her face covered with scars 
and blotches. Text below the title is 
"Take heroin and before long you'll start 

' looking ill, losing weight and feeling like 
death. So, if you're offered heroin, you'll 
know what to say. Heroin screws you 
up." See W. H. Helfand, To Your Health 
{Bethesda, 1990), No. 46. 

\»T:DDING RING, Anonymous, Great Brit- 
ain, c. 1986. NLM Collection. Hands hold- 
ing a piece of paper on which is some 
white powder. The text below the photo- 
graph is "No-one who starts taking heroin 
thinks they'll ever steal for it. But they 
do. Smack isn't worth it." Published by 
the Department of Health and Social Secu- 
rity. See W. H. Helfand To Your Health 
(Bethesda, 1990), No. 44. 


ON YOUR >XnOLE FAMILY, Anonymous, 
Great Britain, c. 1986. NLM Collection. 

Photograph of an outstretched arm, 
scarred by repeated injections. are 
labeled "Mom's housekeeping, Alison's 
'Walkman," etc. A line at the bottom re- 
peats the phrase in the previous poster. 
Published by the Department of Health 
and Social Security. See W. H. Helfand, 
To Your Health (Bethesda, 1990), No. 45. 

64. FACTS ABOUT AIDS, Anonymous, 
Australia, c. 1987. NLM Collection. Text 
only, covering five points: Who can get 
AIDS? What is AIDS?, How do you catch 
AIDS?, You can't catch AIDS by: and How 
to be Safe. Published by the Common- 
wealth Department of Health. 

Anonymous, France, c. 1920. Rockefeller 
Archive, NLM Collections. There are 15 
small ilJustrations, in four groups, how tu- 
berculosis spreads, methods to combat it, 
its enemies and precautions to take. 

STATE BIRD!, Anonymous, U.S.A., c. 
1989. NLM Collection. A drawing of a 
mosquito. At the bottom, the text notes 
that AIDS is not spread by mosquitos, and 
that the poster was developed by teenag- 
ers in Alaska. Published by Alaska AIDS 
Prevention Project, Alaska Department of 
Health and Social Services. 

AIDS, Anonymous, U.S.A., c. 1988. NLM 
Collection. Four photographs, of a hand- 
shake, a place setting, a toilet seat, and a 
hand reaching for a doorknob emphasize 
everyday occurrences that are risk-free 
from AIDS infection. An edition in Span- 
ish also exists. Published by the AIDS In- 
stitute, New York State Health Depart- 

68. GET THE ANSWERS. Ask ask ask 
ask about AIDS, Anonymous, U.S.A., c. 
1987. NLM Collection. The Word "Ask" 
appears in different t\'pe-faces and with 
varying orientations, and a telephone 


THE A'- ' 


96. Sex Exposure Without 
Prophylaxis Is a Help to the 

A World War II poster stress- 
ing prophylaxis against vene- 
real disease, suggested that 
the lack of it helps the Axis 
powers — Germany, Italy and 
Japan. (Courtesy of The Wil- 
liam H. Helfand Collection.) 


number is provided for further informa- 
tion. Published by the AIDS Action Com- 
mittee, Massachusetts. 

AIDS, by Norman Rockwell, U.S.A., c. 
1988. NLM Collection. The AIDS Action 
Committee used an earlier Norman Rock- 
well drawing of a father giving the "facts 

of life" to his son to call attention to the 
necessity of discussing AIDS. 

mous, U.S.A., c. 1987. NLM Collection. A 
photograph of the singer Patti LaBelle, 
with a phone number for further informa- 
tion. Published by the U.S. Public Health 
Ser\'ice and the American Red Cross. 

MOND DECLARE ..., Anonymous, France, 
c. 1935. NLM Collection. An illustration 
of the boxer, Ch. Rigoulot, in a fighting 
pose. The text continues "le secret de ma 
force. Pas d'alcool." Published by the 
Comite National de Defense centre 

mous, Mexico, c. 1988. NLM Collection. 

A drawing, showing the bottoms of a 
dead person's feet, in a morgue. The text 
continues at the bottom, "El SIDA. 
Si ... da." Published by the Direccion Gen- 
eral de Epiedemiologia. 

ARE DYING TO KNO^W, Anonymous, 
U.S.A., 1986. NLM Collection. A row of 
gravestones supports the words in the 
title. Published by the Pharmacist's Plan- 
ning Service, Sausalito, California. 

74. ALERTA SIDA, by R. Cadrena, 
Bolivia, c. 1988. NLM Collection. The let- 
ters S, I, D, and A are filled in with a 
drawing of an anguished figure. At the 
bottom, the "Es SIDA es una 
amenaza. Informate! Published by the 
Ministerio de Prevision Social y Salud Pu- 

blica. See W. H. Helfand, To Your Health 
(Bethesda, 1990), No. 58. 

FERMEDAD EL SIDA, Anonymous, U.S.A., 
c. 1987. NLM Collection. A drawing of a 
skull with an injection syringe in its 
mouth, giving answers to several key 
questions about AIDS. Published by the 
Nipomo, California, Community Medical 

Mauritius, c. 1989, NLM Collection. A 
poster warning of danger in trafficking 
with prostiaites. The illustration is a car- 
toon drawing of six women attempting to 
entice a man. Published by the Health Ed- 
ucation Unit, Ministry of Health. 

Paul Davis, U.S.A., 1985. NLM, Ars Med- 
ica (Philadelphia Museum of Art) Collec- 
tions. A fire eating clown. Published as a 
fund raiser for the East End Gay Organiza- 
tion (Easthampton, New York). 

78. AIDS PREVENTION by David Lance 
Goines, U.S.A., 1985. NLM, Ars Medica 
(Philadelphia Museum of Art) Collections. 
The illustration is of a snake wound 
around an apple on a tree. Published to 
support the Berkeley Student Health Ser- 
vice. See W. H. Helfand, To Your Health 
(Bethesda, 1990), No. 59; Exhibited in "In 
Time of Plague," American Museum of 
Natural History, New York, 1987. 

Anonymous, U.S.A., c. 1987. NLM collec- 
tion. One of four posters in a series of 
"Famous Last Words" published by People 
of Color Against Aids, Seattle. Text only. 

IS NOT WORTH IT, Anonymous, Sey- 
chelles, c. 1988. NLM Collection. Five 
drawings of sporting events, etc. The text 
continues, "In fact, it might give you AIDS 
--which kills. A responsible lifestyle will 








E N 


S 1 


Gf^CKOTUNE 2Q-e07-66S5 

97. A Rubber Is a Friend in 
Your Pocl<et. 

A drawing by Michiael 
Sabanosh, with text in botti 
English and Spanish, was de- 
veloped by the Gay Men 's 
Health Crisis to emphasize 
the value of using condoms. 
(Reproduced with permis- 
sion of GMHC. Courtesy of 
National Library of Medicine 


SUMMER 1990 

fight AIDS." Published by the Ministry of 
Health and Social Services. 

NER, by Ras. Gitten, Trinidad and To- 
bago, 1987. NLM Collection. A drawing 
of a man and woman sitting together on a 
bench. At the bottom, "Avoid AIDS." Pub- 
lished by the Ministry of Health, Welfare 
and Status of Women. 

82. MAG-INGAT SA AIDS, Anonymous, 
Philippines, c. 1987. NLM Collection. A 
poster in a campaign directed to prosti- 
tutes, advising them to supply condoms. 
The drawing shows a silhouette of a man 
and a woman before a hotel; the words 
on the bottom warn "Huwag pumayan 
kung walang kondom." Published by the 
Department of Health, Manila. 

U.S.A., 1988. NLM Collection. A photo- 
graph of a child (versions exist for both 
white and black children), with added 
text "Before you get pregnant, find out if 
you need to be tested." Published by 
Clement Communications, Inc. 

Anonymous, U.S.A., 1988. NLM Collec- 
tion. Photograph of a blonde woman, 
her chin resting on her wrist. The copy 
reads "People can carry the AIDS virus, 
but show no symptoms. Don't take 
chances. Get tested before you become 
sexually involved." Published by Clement 
Communications, Inc. 

DE EL., Anonymous, U.S.A., 1988. NLM 
Collection. A hispanic woman standing 
with arms folded. A similar poster exists 
in English, with an illustration of a white 
woman. The text continues "Cuidate a ti 
misma. Insiste en condones." Published 
by the New Haven Women's AIDS Coali- 
tion of the Mayor's Task Force on AIDS. 

AMOR, Anonymous, Brazil, c. 1987. NLM 

Collection. A blood collecting plastic con- 
tainer in the shape of a heart. Published 
by the Pan American Health Organization 
for the Ministerio da Previdencia e As- 
sistencia Social. See W. H. Helfand, To 
Your Health (Beihesdn, 1990), No. 32. 

U.S.A., 1988. NLM Collection. A glass of 
orange juice, with oranges in the back- 
ground. The text continues, "You won't 
get AIDS— the needles are sterile. So give 
blood and save lives." Published by Clem- 
ent Communications, Inc. See W. H. 
Helfand, To Your Health (Belhesda, 1990), 
No. 31. 

88. STOP AIDS, Anonymous, Switzer- 
land, 1988. NLM Collection. A silhouette 
of a man and a woman next to a palm 
tree; the moon is a condom. Other 
scenes of London, Paris, Rio and Rome 
also show the moon as a condom. Pub- 
lished by AIDS-Hilfe Schweiz. 

Anonymous, Iceland, c. 1987. NLM Col- 
lection. The title is "Keep the Risks of 
your Sex Life to a Minimum" Thirty-four 
photographs of people with condoms; 
some are humorous, some serious. The 
poster is designed to show that condoms 
are a part of daily life. Published by the 
Department of Public Health. See W. H. 
Helfand, To Your Health (Beihesd.i. 1990). 
No. 64. 

mous, U.S.A., 1987. NLM Collection. A 
poster for National Condom Week, Feb. 
14-21. The illustration is a photograph of 

a hand, with a condom on each out- 
stretched finger. 

THOSE, Anonymous, U.S.A., c. 1987. 
NLM Collection. A small photograph of a 
condom, with most of the poster taken by 
the title. Published by the People of 


102. Safe Sex. Are You Man 

In its program to call atten- 
tion to the necessity of prac- 
ticing safe sex, a Los 
Angeles group, The CORE 
Program, commissioned sev- 
eral drawings of gay men by 
Bruce Rapp. (Reproduced 
with permission of The 
CORE Program, Los Ange- 
les. Courtesy of National Li- 
brary of Medicine Collection.) 


Color Against AIDS. Seattle, as one of four 
in a series of "Famous last Words." (See 
also No. 79.) 

ymous, Great Britain, c. 1988. NLM Col- 
lection. The illustration is a condom in a 
pouch. A line at the bottom of the poster 
reads "AIDS. You know the risks. The 
decision is yours." Published by the U. K. 
Health Education Authority. 

Anonymous, U.S.A., c. 1987. NLM Collec- 
tion. A man and a woman embracing. 
The text below the title is "AIDS is a 
killer. Use a condom." Published by Tur- 
tledove Communications, Inc. 

lES, Anonymous, Australia, c. 1988. NLM 
Collection. A comic strip character says 
"Don't be shame. Be game." Published 
by the Commonwealth Department of 
Community Services and Health, Aborigi- 
nal Health Workers of Australia. See W. 
H. Helfand, To Your Health (Belhesda, 
1990), No. 63. 

Australia, c. 1988. NLM Collection. A 
comic strip with six panels illu.strating the 
danger of AIDS infection from multiple 
sexual partners. The line at the bottom 
reads "You can't cure AIDS, you can only 
be careful. Use a condom!" Published by 
Commonwealth Department of Commu- 
nity Services and Health, NACAIDS, Ab- 
original Health Workers of Au.stralia 

Anonymous, U.S.A., c. 1942. Helfand 
(New York) Collection. The illustration 
shows Hitler, Tojo and Mussolini who say 
"Thanks Friends!!" as they look at hospital 
beds in a ""Venereal Disease Ward." At 
the bottom the text reads "Prophylaxis Pre- 
vents Veneral Disease." See A. Brandt, No 

Magic Bullet (New York, 1985), after p. 

POCKET, by Michael Sabanosh, U.S.A., 
1987. NLM Collection. A drawing of a 
man's torso, .showing the outline of a con- 
dom in his pocket. The text is repeated 
in Spanish below the iUu.stration. Pub- 
lished by the Gay Men's Health Crisis, 
New York. 

MANN, Anonymous, Switzeriand, c. 1988. 
NLM Collection. Photographs of a man's 
cuff links, necktie, bracelet and condoms 
and a tube of lubricant. Published by the 
Hot Rubber Company, Zurich. 

by George Delany, U.S.A., 1987. NLM Col- 
lection. Photograph of a large condom, 
with the title words in small type along- 
side it. 

U.S.A., 1986. NLM Collection. Photo- 
graph of two men (versions exist for ei- 
ther black or white men) ready to 
undress. A line at the bottom notes "Use 
condoms. There's living proof they stop 
AIDS." Published by HERO (Health Edu- 
cation Resource Organization), Baltimore. 

ENOUGH?, by Bruce Rapp, U.S.A., c. 
1987. NLM Collection. Drawing of a man 
holding a condom in his right hand. 
Copyright from The CORE Program, Los 
Angeles. See W. H. Helfand, To Your 
Health (Bethesda, 1990), No. 60. 

ENOUGH?, by Bruce Rapp, U.S.A., c. 
1987. NLM Collection. Drawing of three 
muscular men, one wearing a militaiy 
cap. Copyright from The CORE Program, 
Los Angeles. See W. H. Helfand, To Your 
Health (Bethesda, 1990), No. 61. 

SAFE, Anonymous, U.S.A., c. 1987. NLM 

109. I.V. Drug Users: Don't 
Give AIDS to Your Unborn 

In their attempt to reach 
women of childbearing age 
who might become pregnant, 
the Georgia Department of 
Human Resources published 
this moving poster of a fetus 
holding a syringe. (Courtesy 
of National Library of Medi- 
cine Collection.) 


SUMMER 1990 

1 14. Lasst Mich Nicht Allein. 

A German poster suggest- 
ing ttie need for compassion 
for AIDS patients. (Courtesy 
of National Library of Medi- 
cine Collection.) 

Collection. Photograph of the muscular 
torso of a man, with the copy in small 
type in the lower left corner. Published 
by P S Atlanta. 

c. 1988. NLM Collection. Cartoon draw- 
ing of two men, their speech in baloons 
in comic strip style. A lengthy text gives 
details of a "sexual enrichment workshop 
for gay and bisexual men." Published by 
the Colorado AIDS Project. 

PLEASE A LOVER . . ., Anonymous, 
U.S.A., c. 1988. NLM Collection. Fifteen 
photographs, mainly of homosexual men 
in a variety of activites. A final photo- 
graph is of a package of condoms and a 
jar of lubricant. Published by the Tuscon 
AIDS Project. 

U.S.A., c. 1988. NLM Collection. Six 
drawings of men, each accompanying 
copy on one of the themes in the title. 
The poster is designed to be cut so that 
SLX individual posters can be made; each 
proposes a method of practicing safe sex. 
Published by the Colorado AIDS Project. 

107. HEY MAN! NO SHARING, Anon- 
ymous, U.S.A., c. 1988. NLM Collection. 
A drawing by an intravenous drug user of 
two men; the title is spoken by one of 
them. Published by the Brooklyn (N.Y.) 
AIDS Task Force. 

mous, Switzerland, c. 1987. NLM Collec- 
tion. A large syringe with a bent needle, 
at the point of which are the words "Stop 
AIDS." Published by AIDS-Hilfe Schweiz. 



mous, U.S.A., c. 1988. NLM Collection. A 
large syringe cradled in the arms of a well- 
developed fetus. The text continues, "Get 
the test before having a baby." Published 
by the Georgia Department of Human Re- 

GET AIDS, Anonymous, Great Britain, 
1987. NLM Collection. A hand holding a 
syringe. The hand as well as a handker- 
chief on a table is covered with blood. A 
line at the bottom reads, "In some parts of 
the country, as many as 1 in 2 drug injec- 
tors carries the AIDS virus. Don't inject 
AIDS." See W. H. Helfand, To Your 
Health (Bethesda, 1990), No. 66. 

Anonymous, Great Britain, 1987. NLM 
Collection. Photograph of a syringe and a 
spoon on a bloody cloth. A line at the 
bottom reads, "The AIDS virus can live on 
a needle, syringe or equipment. Never 
share, not even once. Don't inject AIDS." 

U.S.A., c. 1987. NLM Collection. Two 
hands, one a skeletal hand holding a sy- 
ringe; on the other side an outstretched 
hand ready to take the syringe. Published 
by the National Advisory Committee on 
AIDS. See W. H. Helfand, To Your Health 
(Bethesda, 1990), No. 67. 

Anonymous, U.S.A., 1988. NLM Collec- 
tion. Drawing of the rear view of a man 
sitting m a chair, elbows on his knees. 
The text continues, "Give him your sup- 
port and compassion. He needs you." 
Published by Clement Communications, 

Anonymous, Germany, c. 1988. NLM Col- 

leant mate >ou Sick 


lection. Photograph of a man sitting on a 
bench. Extensive text below the title and 
the slogan "Gib AIDS keine chance." Pub- 
lished by Die Bundesgesund Heits- 

... I CAN'T MAKE YOU SICK, Anony- 
mous, U.S.A., c. 1989. NLM Collection. A 
child's drawing of a child among flowers. 
Below the illustration a telephone number 
is given for the "AIDS hotline for kids." 
Published by the Center for Attitudinal 
Healing, Tiburon, California. 

115. I Have AIDS. Please 
Hug Me. I Can't Make You 

The child's drawing is an ef- 
fective means for communi- 
cating information on an 
"AIDS hotline for kids. " (Re- 
produced with permission of 
the Center for Attitudinal 
Healing. Courtesy of Na- 
tional Library of Medicine 


SUMMER 1990 


William H. Helfand has recently retired 
after more than thirty-three years as an ex- 
ecutive with a multinational pharmaceuti- 
cal company. He is a consultant to the 
National Library of Medicine and the Phila- 
delphia Museum of Art in areas relating to 
art and medicine. He has degrees in 
Chemical Engineering (University of Penn- 
sylvania, 1948), Pharmacy (Philadelphia 
College of Phamiacy and Science, 1952), 
and was awarded degrees (h.c.) of Doctor 
of Humane Letters by the Albany College 
of Pharmacy, Union University, in 1981 
and Doctor of Science by the Philadelphia 
College of Pharmacy and Science in 1976. 
Dr. Helfand has published four books: 
Medicine and Pharmacy in American Po- 
litical Prints ^M.i.d\son, 1978); Medicine 
and Pharmacy: 100 years of Poster Art 
(Albany, 1981); and with Sergio 
Rocchietta, Medicina e Farmacie Nelle 
Caricature Politiche Italiane (Milan, 
1982). With David Cowen, he is the au- 
thor of Phamiacy: An Illustrated Histoiy 
(New York 1990). He has published a 
number of articles on the history of phar- 
macy, and on prints, caricatures, posters 
and ephemera relating to pharmacy and 
medicine in Pharmacy in History. Medical 
History, Rei'ue dHistoire de la Phamiacie 
and other journals. Exhibition of portions 
of his collection of prints and ephemera 
in the fields of medicine and pharmacy 
have been held in Toronto, Las Vegas, 
Miami, Philadelphia, New Haven (Yale 
University School of Medicine), Washing- 
ton (Smithsonian Institution and National 
Library of Medicine), Paris, New York and 
Haarlem, The Netherlands. 

In October, 1991, the Philadelphia Mu- 
seum of Art will open an exhibition, "The 

Picture of Health," composed of objects 
he has donated in recent years. He has 
lectured at the American Museum of Natu- 
ral History, British Society of Apothecar- 
ies, College of Physicians of Philadelphia, 
Medical College of Pennsylvania, Philadel- 
phia College of Pharmacy and Science, 
Philadelphia Museum of Art, Rockefeller 
University, University of Pennsylvania, 
University of Wisconsin, Yale University 
School of Medicine and other institutions. 

In 1986, Dr. Helfand received the 
Pepys Medal of the Ephemera Society, 
London, for outstanding contributions in 
the field of ephemera studies, and in 1972 
he received the Kremers Award of the 
American Institute of the History of Phar- 
macy; in 1991 he will be the recipient of 
the Urdang Medal for distinguished histori- 
cal writing from the same organization. 
He is a Trustee of the Medical Historical 
Library, Yale Medical School, New Haven; 
has been president of the American Insti- 
tute of the History of Pharmacy, and has 
been elected to membership in the Inter- 
national Academy of the History' of Phar- 
macy, the Nobile Collegio Chimico 
Farmaceutico di Roma, the Academic 
Nationale de Pharmacie, Paris, and the 
Academy of Pharmaceutical Sciences. Dr. 
Helfand is presently working on a book 
about medical and pharmaceutical posters. 


The Poster Collection at the 
National Library of Medicine 

A few months ago, a social 
worker from a nearby county 
health department phoned to arrange 
an appointment to view the National 
Library of Medicine's (NLM) poster 
collection, particularly materials on 
drug addiction. His department was 
preparing to make its own set or se- 
ries on this subject, aimed at a teen- 
age audience. When he heard about 
the NLM collection, he assumed that 
it might provide some good ideas for 
his professional colleagues and the de- 
sign staff. 

This patron arrived two weeks 
later with four other staff members. 
There were 123 posters on drug 
abuse in the collection at that time, all 
in one drawer and relatively easy to 
review. As I showed them each 
poster, their interest level and enthusi- 
asm increased. Here were posters 
from all over the world on the subject 
matter they needed: dramatic, grim 
posters from England; artistically so- 
phisticated posters from America and 
France; simple, direct posters from 
Third World countries, humorous post- 
ers from Germany; all produced by 
health professionals very much like 
themselves. Their original mission, es- 
sentially to "borrow" a single poster 

which could send an effective mes- 
sage to adolescents in a Washington, 
D.C. suburb, was not attainable. 

They were, however, able to iden- 
tify sponsoring groups and institutions 
with similar tasks and problems. One 
state health department was produc- 
ing particularly .stylish, positive post- 
ers for an ethnically diverse audience, 
and this group admired their work. I 
confirmed that we could make a re- 
production of the poster, but sug- 
gested instead that they call the 
people who produced it. They 
seemed quite enthusiastic over the 
prospect of establishing contact, and 
it seems reasonable to assume that 
the subsequent phone call led to use- 
ful networking and resource sharing 
among the two groups of social 

The preceding incident is a good 
example of how this new special col- 
lection can serve a different role from 
the traditional one of a picture collec- 
tion, i.e., having pictures which satisfy 
patron needs, and producing photo re- 

At the other end of the chain— the 
sponsoring groups that initiate these 
posters— we have found that such 
groups are often surprised and 

by Lucinda H. Keister 


SUMMER 1990 

delighted to know that their work is 
being added to the NLM collection. 
Many posters obviously show much 
careful thought and a high level of ar- 
tistic talent in their design. Small 
sponsoring groups are proud of these 
publications, but also are aware they 
are essentially ephemeral. They find 
it rewarding to have the works attain 
a measure of immortality by being in- 
corporated into the special collection 
of a national library. 

One would not expect at first 
blush that the mission of the National 
Pediculosis Association would yield 
the lively, charming, upbeat, and very 
effective posters they produce. How- 
ever, their strategy to attack the 
stigma attached to lice resulted in just 
that type of poster—by their sponsor- 
ing a "National Head Lice Awareness 
Poster Contest" among school chil- 
dren. The winner of the contest, a 
kindergartener from Ft. Worth, Texas, 
produced one of the most expressive, 
effective drawings in our entire prints 
and photographs collection— a study 
in human frustration composed en- 
tirely of sixteen strokes of a crayon. 
Consequently, our holdings from this 
association reveal not only an appeal- 
ing set of posters, but also the clever 
thinking behind the program. 

The special collection into which 
these posters have come is a very old 
indulgence of John Shaw Billings, 
head of the Library of the Surgeon 
General of the United States Army 
(the predecessor of the National Li- 
brary of Medicine) from 1865-1895. 
Archival documentation shows that 
Billings, when offered the opportunity 

to purchase large groups of engraved 
portraits of figures famous in medical 
history, was keen enough on the idea 
that he found the money to add this 
non-print material to the holdings of 
the Library. Evidence of these acqui- 
sitions appears in the Index Catalog 
of the Libraiy of the Surgeon 
General's Office m the First Series 
(Vol.1, pp. 271-292), with the lengthy 
listing under "Collection of portraits." 

Portraits were not the only type of 
prints purchased, however. Some 
fine English caricatures also came into 
the collection. The Library's picture 
collection essentially remained dor- 
mant and somewhat inaccessible until 
the 1950s. During Worid War II, 
when the fine rare book holdings of 
the Army Medical Library were tempo- 
rarily moved to Cleveland, Ohio, for 
safekeeping, these prints were still a 
part of the Reference Division in the 
red brick building on the Mall in 
Washington, D.C. It was not until the 
1950s that the NLM's holding were 
properly cataloged, using its own na- 
tional classification scheme, and ac- 
commodation for the small print 
collection can be seen in the NLM 
Classification Manual." 

Today, the Library's Prints and Pho- 
tographs Collection consists of some 
56,000 items and serves about 2,000 
patron requests per year with over 
6,000 photo reproductions. The bulk 
of the collection consists of portraits 
now numbering close to 30,000. The 
remainder consists of nineteenth- and 
twentieth- century photographs and 
all variety of print media (lithographs, 
etchings, wood engravings, etc.). 

16. Stamp Out V.D. 

Among the posters proliferat- 
ing during World War II were 
those warning of venereal 
disease. This poster shows 
Uncle Sam's foot ready to 
step on the letters "V.D." 
(Courtesy of National Library 
of Medicine Collection.) 


separated into logical physical groups: 
albums, images of medical institu- 
tions, fine art print material, posters, 

Although the collection has in- 
cluded some posters for many years, 
a special effort to expand poster hold- 
ings, and especially to collect contem- 
porary as well as historical posters, 
was begun in 1987. The decision to 
acquire posters actively, while adding 
an interesting dimension to the collec- 
tion, brought with it the necessity to 
assume an extra burden of work at a 
time when our small staff was busy 
with both their regular tasks and one 
major project, an effort to put the en- 
tire pictorial collection on a videodisc, 
linked to computerized catalog re- 
cords. Consequently, there was not 
adequate time to prepare for the ad- 
vent of the posters, which began to ar- 
rive at an amazing rate. We were 
immediately confronted with a prob- 
lem of storage. Fortunately, there 
was some mapcase space available, 
but more importantly, the time was 
propitious for adding the posters to 
the filming queue for the videodisc. 
Patrons commonly entertain the as- 
sumption that they can browse 
through our prints and photographs 
collection. However, as is the case 
with most large still picture collec- 
tions which do not have reference 
copies of their images, it is in reality a 
fatiguing and inefficient process to 
look directly at the picture holdings 
themselves. Most patrons will be 
much more agreeable to browsing 
through the collection in the comfort 

of a desk chair with a television moni- 
tor and videodisc player. 

Two major tasks confronted me as 
a curator: appropriate individual stor- 
age of these posters, and the appropri- 
ate classification and cataloging 
procedure for them. I had one 
mapcase unit with ten drawers mea- 
suring 49 inches wide by 38 inches 
deep. I ordered two more enameled 
steel mapcases, the first one with 
much smaller, narrower drawers, the 
second in an intermediate size. I also 
plan to have a pallet constructed in 
the collection's storage area to accom- 
modate the exceptionally large post- 
ers, so that they can remain in a 
horizontal position. This will give 
four storage locations to accommo- 
date the amazing variety of sizes, and 
I would be reluctant to add any more 
locations for viewing or retrieval. 

I also had to ascertain how the 
posters should be stored within the 
drawers. Fortunately I had made a 
trip several years earlier to the archi- 
tectural drawings section of the Ameri- 
can Institute of Architects. The 
curator and her assistant were ex- 
tremely satisfied with their very large, 
heavy, 4 mil Mylar folders. This 
method of protecting large thin docu- 
ments requires that the folder be at a 
minimum several inches larger than 
the item it holds. Leaving a generous 
margin of Mylar around the perimeter 
assures that static electricity will act to 
bind the margins together, keeping 
the folder closed and the poster from 
slipping around during handling. 
These folders can be sealed on only 
one side or on two adjacent slides, 


SUMMER 1990 

making what is called an "L-seal." 
The L-seal folders offer more protec- 
tion, but greater care needs to be 
taken when inserting the poster, most 
especially when it is fragile. These 
folders work well as a temporary or a 
long-term storage method. Rare, ex- 
pensive, fragile posters are mounted 
on linen by a conservator, but the 
vast majority of our posters will be ad- 
equately protected by these custom- 
made, chemically inert folders. 
Moreover, there is no staff time spent 
preparing some kind of opaque 
folder, and no public service time 
spent opening up an opaque folder to 
look at its contents in cases where 
someone needs to look at the posters 
directly. Mylar is indeed a time -saver 
in visual collections, and well worth 
the cost. 

The most interesting and challeng- 
ing part of the poster project turned 
out to be the puzzle of how to cata- 
log and cla.ssify them. Did they even 
need to be classified? I considered 
briefly simply numbering them con- 
secutively. Appropriate access points 
could be provided through the de- 
scriptive cataloging. Other curators, 
especially archivists, would consider 
cataloging them as a whole group. 
However, still pictures are not 
searched as a group by the public 
that will use them, but rather as indi- 
vidual information documents. Fur- 
thermore, still pictures immediately 
become individual information docu- 
ments when they are accessible on a 
videodisc, as our images will be. 

My final decision was to group the 
posters by subject, and classify and 

catalog them individually. This 
would be consistent with the rest of 
the material in the Prints and Photo- 
graphs Collection. The system begins 
with an NLM subject classification 
number, for example, WA 590 
("Health Education"). This is fol- 
lowed by the alpha-numeric code "C 
25," which indicates a still picture 
group, and then individual consecu- 
tive numbers for individual images 
within that grouping. The code "C 
25" can be varied to accommodate 
multiple groups. Thus, a World War 
II poster on venereal disease preven- 
tion would carry a typical call num- 
ber, WA 590 C25 no. 83; the fifth 
poster to be cataloged into the alco- 
holism grouping has the class number 
WA 590 C 35 no. 5. Within this aug- 
mented poster collection, the alpha- 
numeric codes run from "C 20 " 
through "C 40." 

It was necessary to wait until there 
were about 1,200 posters to decide 
how to classify them into groups. De- 
fining subject groups within large pic- 
ture collections is an organic process 
in which the content of the material 
and the curator's goals interweave 
until appropriate size groups emerge. 
It is naive to impose arbitrarily a se- 
ries of subject groupings on material 
because it is likely that these catego- 
ries—however well thought out— proba- 
bly will not reflect the intellectual 
content of the material. As I sifted 
through these many posters, I could 
see natural groupings evolve, some 
quickly, some slowly: mother and 
child care, environmental health, 
good nutrition, etc. Because I wanted 

68. Get the Answers. Ask 
Ask Ask Ask about AIDS. 

The AIDS Action Committee 
of Massachusetts used a vari- 
ety of typefaces to attract at- 
tention in their drive to 
communicate information 
about AIDS. (Courtesy of Na- 
tional Library of Medicine) 


the names of the groupings to be 
MeSH headings, I brought in a staff 
member of NLM's Indexing Section to 
check my preliminary title selections 
for these groupings. "Healthful Life 
Styles" then became "Health Behav- 
ior" and "Drug Addiction" is now "Sub- 
stance Abuse", for example. I 
expanded the existing poster classifi- 
cation scheme and set up a number- 
ing system which should be flexible 
enough to accommodate whatever 
changes come up. We now have 
twenty groupings, the largest being 
the outstanding posters on AIDS. The 
descriptive cataloging for each poster 
is in the MARC Visual Materials format 
and will carry as much information as 
the majority of our users will need to 
retrieve the item, such as subject 
terms, publishing and sponsoring or- 
ganization, country of origin, date, 
and brief description of the visual. 
With 3,500 posters, we already 
have a most impressive collection that 
will gain in significance as it contin- 
ues to grow. The subject sub- 
groupings contain posters from 
countries throughout the world, 
thereby providing researchers with a 
meaningful comparison of ap- 
proaches to specific public health 
problems by various cultures and gov- 
ernments. Additionally, because the 
subgroups are so large, there is some- 
thing to be learned both from the 
numbers of different countries produc- 
ing posters on a given subject and 
also the proportional numbers of post- 
ers from individual countries within 
the subject groups. There are many 
other such research possibilities to be 

107. Hey Man! No Sharing. 

A drawing by an intravenous 
drug user, used by the Broolf- 
lyn AIDS Tasl< Force in an at- 
tempt to curtail the practice 
of sharing needles. (Cour- 
tesy of National Library of 
Medicine Collection.) 

revealed by this large collection of 
public health education documents, 
probably as many possibilities as we 
will have users studying them. We 
are pleased to have this rich collec- 
tion as part of the National Library of 
Medicine's information resources. 


1. W. D. Miles, A History of the Na- 
tional Library of Medicine (Washing- 
ton, D.C.: Government Printing 
Office, 1982), 82-83. 

2. National Library of Medicine, Na- 
tional Library of Medicine Classifica- 
tion, 4th ed., rev. (Washington, D.C.: 
Government Printing Office, 1981), 


SUMMER 1990 

Evolution of Federal Dietary 
Guidance Policy: From Food 
Adequacy to Chronic Disease 

Current dietary recommendations 
to improve the health of the gen- 
eral public are distinctly different— and 
have been decidedly more controver- 
sial—than those proposed by the 
federal government in the early part 
of this cenairy. Whereas earlier re- 
commendations urged Americans to 
consume foods from multiple groups 
in order to avoid nutrient deficiencies, 
more recent advice emphasizes restric- 
tion of dietary components to reduce 
risk factors for chronic diseases. De- 
spite this difference, old and new 
federal recommendations share one 
feature in common: they promote 
use of the full range of American 
food and agriculture products without 
restriction. The concept of food 
groups reflects this range— it has been 
accepted by scientists, health profes- 
sionals and the food industry without 
significant argument. Because reduc- 

tions in intake of dietary components 
associated with chronic disease imply 
the need to limit intake of certain 
foods, recent recommendations have 
elicited intense debate over the na- 
ture of the dietary changes deemed 
necessary, the reliability of the evi- 
dence on which such advice is based, 
and the population to which recom- 
mendations are targeted. 

The significance of these issues be- 
comes apparent by examining the 
changes that have taken place in U.S. 
dietary guidance policy between the 
time that one government scientist 
first published tentative dietary advice 
in 1894 and the Public Health Service 
and the National Research Council 
(NRC) issued massive consensus re- 
ports in the late 1980s. In this essay, 
we examine the rationale for dietary 
recommendations, the role of specific 
interest groups in their development. 

by Marion Nestle and Donna V. Porter 

'Revised version of a paper presented at the annual meeting of the American Association for the History 
of Medicine in Birmingham. Alabama, on April 30. 1989- The authors thank Betty Peterkin for provid- 
ing copies of many of the documents cited here. The views expressed are those of the authors and do 
not necessarily reflect those of the Congressional Research Sennce or the Library of Congress. 



and their implications for disease pre- 
vention in individuals and in the gen- 
eral population. 

Early Nutrition and Health in the U.S. 

The first American settlers obtained 
foods through farming, hunting and 
gathering, and— to a limited extent— in- 
ternal and external trade. Thus, the 
diet varied according to season, cli- 
mate and location. As trade became 
more extensive, variations with social 
status became more apparent. In- 
creasing industrialization and urban- 
ization fostered improved methods of 
food preservation, storage and distri- 
bution, factors that enabled diets to 
become more stable." 

Early reports of dietary intake pat- 
terns were based on anecdotal infor- 
mation or data from limited popu- 
lation samples. The U.S. Department 
of Agriculture (USDA) conducted its 
first national surveys of food availabil- 
ity in 1909, of household food con- 
sumption in 1936 and 1937, and of 
the food intake of individuals in 
1965. Thus, the health conse- 
quences of early dietary practices can 
only be inferred. In 1900, most of the 
leading causes of death in the U.S. 
were infectious diseases such as influ- 
enza, typhoid, diphtheria and whoop- 
ing cough. Malnutrition and nutrient 
deficiency diseases were reported fre- 
quently, especially among the poor. ' 

As housing, sanitation and nutri- 
tion improved, infectious diseases de- 
clined in prevalence but were 
overtaken by chronic diseases associ- 
ated with excessive or unbalanced di- 

etary intake. Of the ten leading 
causes of death in 1987, five (coro- 
nary heart disease, certain cancers, 
strokes, diabetes and atherosclerosis) 
have been associated with diet, and 
another three (motor vehicle acci- 
dents, suicides, and chronic liver dis- 
ease and cirrhosis) with alcohol. 
Epidemiologists could identify correla- 
tions between diet and these diseases 
more precisely when the National 
Center for Health Statistics added a 
nutrition component to its national 
health suney in 1971. 

The First Food Groups^ 

The earliest dietary recommenda- 
tions were developed by the USDA. 
A primary mandate for this agency, 
which was created in 1862, was to 
"diffuse among the people of the 
United States useful information on 
subjects connected with agriculture in 
the most general and comprehensive 
sense of that word." In the early 
1890s, the USDA began to sponsor re- 
search on the relationship between ag- 
ricukure and human nutrition. W.O. 
Atwater was appointed as the first di- 
rector of its Office of Experiment Sta- 
tions. Atwater published tables listing 
the content of calories, protein, carbo- 
hydrate, fat and "mineral matters" in 
common American foods. 

He also estimated the amounts of 
food substances needed to meet the 
nutrient requirements of people per- 
forming varying levels of Vv'ork. His 
analysis of the eating habits of New 
England laborers and professionals 


SUMMER 1990 

. . . the general impression of 
hygienists that our diet is one- 
sided and that we eat too 
much . . . fat, starch, and 
sugar. This is due partly to 
our large consumption of 
sugar and partly to our use of 
such large quantities of fat 
meats. . . . How much harm 
is done to health by our one- 
sided and excessive diet no 
one can say. Physicians tell 
us that it is very great. 

Atwater stated that American men 
required more calories and protein 
than was recommended by European 
physiologists of that era because "... 
people in this country work harder 
and need ampler nourishment than is 
common among wage workers in Eu- 
rope." He "ventured to suggest a 
standard with . . . 3,500 calories of en- 
ergy for the man at moderate muscu- 
lar work," with a distribution that 
calculates to 15 percent of calories 
from protein, 33 percent from fat, and 
52 percent from carbohydrate. 
These recommendations, which re- 
quired a substantial decrease in fat in- 
take and an increase in carbohydrate 
intake, are remarkably similar to cur- 
rent advice. 

Atwater's food tables did not in- 
clude vitamins. Although diseases 
such as scurvy, beriberi and pellagra 
were known to be associated with 
diet, no vitamin had yet been iso- 
lated. As scientists identified the struc- 
ture and function of the vitamins, " 
the USDA began to translate these dis- 
coveries into advice for consumers. 

By 1917, the agency had produced at 
least thirty pamphlets to inform 
"housekeepers" about the nutritive 
value of foods, the role of specific 
foods in the diet, and foods appropri- 
ate for young children at home or at 

The USDA's first set of dietary rec- 
ommendations appeared in a fourteen- 
page pamphlet entitled How to Select 
Foods, which listed the nutrient sub- 
stances needed for health and 
grouped foods providing these sub- 
stances into five groups— fruits and 
vegetables; meats and other protein- 
rich foods (including milk for chil- 
dren); cereals and other starchy 
foods; sweets; and fatty foods. "* This 
pamphlet is notable in that it sets 
forth the principles that govern USDA 
dietary guidance policy to this day. 
No specific foods or combinations of 
foods were recommended. As the au- 
thors explained in their introduction, 
the pamphlet 

. . . tells very simply what the 
body needs to obtain from its 
food for building its tissues, 
keeping it in good working 
order, and providing it with 
fuel or energy for its muscu- 
lar work. It shows in a gen- 
eral way how the different 
food materials meet these 
needs and groups them ac- 
cording to their uses in the 

In this publication the authors ig- 
nored Atwater's advice to limit intake 
of fat and sugar. Instead, they 



emphasized the need to include 
newly discovered nutrients in the 
diet. This emphasis was supported 
by food manufacturers and agricul- 
tural producers, who realized that the 
market for their products "was lim- 
ited: Americans had enough to eat 
and could not be persuaded to eat 
more food. This meant that any in- 
crease in the consumption of one 
food commodity would have to be at 
the expense of others." The new 
discoveries could be exploited to pro- 
mote foods containing vitamins neces- 
sary for optimal growth, health and 
longevity and to encourage pur- 
chase of the full range of American ag- 
ricultural products. As explained by 
the USDA in 1923, all foods contrib- 
ute to healthy diets: 

The number of different food 
materials available in most 
parts of the United States is 
very great and is constantly 
increasing as a result of im- 
proved methods of agricul- 
ture. . . . There is no one of 
all these many foods that can- 
not be introduced into the 
diet in such a way as to con- 
tribute to its wholesomeness 
or its attractiveness. . . . 

The food group approach was 
adopted immediately by the U.S. 
Food Administration as a means to 
sustain the food supply during World 
War I. This agency urged housewives 
to conserve food and to substitute nu- 
tritionally comparable foods within 
each of the five groups. During the 

next decade, five food groups served 
as the basis of USDA dietary advice to 
families, mothers of young children 

A . 20 

and teenagers. 

By the 1930s, the USDA had identi- 
fied certain foods as especially rich 
sources of vitamins and minerals. Its 
dietary advice began to reflect not 
only the physiologic needs for such 
foods but also the ability of consum- 
ers to pay for them. The economy 
food plan in Diets at Four Levels of 
Nutritive Content and Cost,' how- 
ever, failed to achieve minimal dietary 
standards for use of protective foods, 
implying for the first time that the 
poor could not be expected to afford 
anything more than a marginally ade- 
quate diet."" Noting that the selection 
of foods by consumers has far-reach- 
ing implications for agriculture, this 
publication increased the number of 
food groups to twelve and included, 
for the first time, milk as a separate 

The Recommended Dietary Allowances 

In 1940, the National Academy of 
Sciences established a Committee on 
Food and Nutrition under the aus- 
pices of the National Research Coun- 
cil to advise the government about 
nutrition problems that might affect 
national defense. One of the first 
tasks of this committee, which be- 
came the Food and Nutrition Board in 
1941, was to establish standards for 
daily nutrient intake for the armed 
forces and for the general popula- 
tion." The committee presented Rec- 
ommended Dietary Allowances 


SUMMER 1990 

(RDAs) for energy and eight nutrients 
at a National Nutrition Conference on 
Defense in May of 1941. Since 1943, 
committees have developed revised 
editions at approximately five-year in- 

RDAs provide guidelines for indi- 
viduals according to age, activity 
level, gender and body size. The 
tenth edition established standards for 
nineteen nutrients and ranges of in- 
take considered "safe and adequate" 
for another seven. Although the 
RDAs were designed originally to im- 
prove nutritional status as an aid to 
national defense, they have been 
used since to access dietary ade- 
quacy, to interpret food consumption 
records, to establish levels of food as- 
sistance, to evaluate the nutritional sta- 
tus of individuals and populations, to 
label food products, and to develop 
nutrition education and dietary coun- 
seling guidelines." 

Because the RDAs affect so wide a 
range of nutrition policies, their limita- 
tions require careful attention. RDAs 
are established at levels designed to 
exceed the requirements of practically 
all healthy people. Most individuals 
can consume amounts of nutrients sig- 
nificantly below RDA levels and still 
meet dietary requirements. These fig- 
ures are estimates of the nutrient 
needs of populations and may be in- 
appropriate for individuals with other 
than average nutrient requirements. 
Thus, it has proved difficult to trans- 
late these standards into a universally 
applicable pattern of food choices. 
As chronic diseases have replaced de- 
ficiency diseases as leading causes of 


Then eat other foods you o/so like 


death, these limitations have led to in- 
creasing controversy over application 
of the RDAs. This controversy has cul- 
minated most recently in the pro- 
longed delay in publication of the 
■ tenth edition discussed later. 

The War Years: Food Groups Continued 

Wartime rationing of meat, sugar, 
butter and canned goods inspired vari- 
ous federal agencies to develop new 
guidelines based on both pragmatic 
considerations of food availability and 
theoretical considerations of nutrient 
requirements." In 1942, U.S. agen- 
cies instructed Americans to "do your 
part in the national nutrition program" 
by eating foods every day from eight 

During World War II, the gov- 
ernment recommended daily 
consumption of foods from 
at least eight groups to pre- 
vent nutritional deficiencies. 
In contrast, current advisors 
emphasize reduced intake of 
butter, eggs and high-fat 
meat and dairy foods to pre- 
vent diet-related chronic 

(Reproduced from U.S. 
Needs US Strong, Washing- 
ton, D.C.: Office of Defense 
Health and Welfare Services, 


groups. Four of these groups were 
milk, meat, eggs and butter," all 
sources of fat and cholesterol as well 
as vitamins and minerals. The follow- 
ing year the USDA issued the Na- 
tional Wartime Nutrition Guide with 
the slogan, "U.S. needs us strong: eat 
the Basic 7 every day."" The Basic 
Seven combined meat, eggs, fish and 
beans into one group, kept milk as a 
separate category, and retained fats 
and sugars (which later would be sub- 
stances to avoid) as separate groups. 

The changing number of food 
groups in these guides reveals the 
lack of coordination not only be- 
tween federal agencies but also 
within the same agency. In 1943, for 
example, the USDA published the 
Basic Seven but instructed wartime 
homemakers to plan low- and moder- 
ate-cost meals based on purchases 
from eleven food groups.' 

The Postwar Years: Food Groups 

Two USDA publications in 1946 
continued these inconsistencies. The 
National Wartime Nutrition Guide 
was published without significant 
change for peacetime use as the Na- 
tional Food Guide. It contained this 

"This is the Basic 7 guide for well- 
balanced meals. In time of emer- 
gency, you need to eat less of the 
scarce foods, more of the plentiful. 

Two months later, the same USDA 
agency issued Food for Growth: Food 


UPaily Food Guid^ 



for Freedom, targeted to school chil- 
dren in the fourth through sLxth 
grades. This publication was the first 
to recommend selections from just 
four food groups— milk, vegetables 
and fruit; eggs, meat, poultry or fish 
(sometimes dried beans or peas); and 
bread, cereal, cookies and cakes. 

In the early 1950s, USDA nutrition- 
ists compared the results of the Na- 
tionwide Food Consumption Survey 
to the most recent RDAs and noted 
that the diets of many Americans 
were below standard for several nutri- 
ents. A new food guide was needed 
to "help the average person choose 
his food more wisely." To ensure 
that recommendations would produce 
diets that met the RDAs, nutritionists 
simplified the four groups to milk (re- 
taining its position as a separate cate- 
gory); vegetables and fmits; meats; 
and breads and cereals. They also 

The 1958 version of the 
Basic Four Food Groups 
gave equal weight to the Milk 
and Meat groups and listed 
them first. 

(Reproduced from Food for 
Fitness: A Daily Food Guide, 
Leaflet no. 424, U.S. Depart- 
ment of Agriculture, March 


SUMMER 1990 

specified the number and size of serv- 
ings within each group. 

In an effort to achieve consensus 
on these categories, the USDA invited 
leading nutrition authorities in govern- 
ment, research, the food industry and 
agricultural commodity groups to re- 
view preliminary drafts because "it 
was felt that food industry groups 
would have a vital interest in any 
food guide sponsored by the govern- 
ment," as indeed they did: "The 
meat industry groups were unhappy 
about the serving size indicated for 
meat. . . . They pointed out that this 
size is smaller than average."' 

In response to these and other 
comments, USDA officials reviewed 
the document and produced it first as 
a handbook for nutrition profession- 
als and later for the general public 

as Food for Fitness: a Daily Food 
Guide Versions of this guide, 
known popularly as the Basic Four, 
remained the principal instmment of 
USDA dietary guidance policy until 
1980, although family meal and cost 
plans continued to be based on 
eleven food groups." 

The Need for New Dietary Guidance 

In 1967, a report of an investiga- 
tion of hunger and malnutrition 
among low-income groups in the U.S. 
became the subject of a television doc- 
umentary that shocked the nation." 
The report called for immediate ex- 
pansion of federal food assistance pro- 
grams to correct the conditions that 
had been observed, and it noted that: 

The failure of federal efforts 
to feed the poor cannot be di- 
vorced from our nation's agri- 
cultural policy, the Con- 
gressional committees that 
dictate that policy, and the 
Department of Agriculture 
that implements it; for hunger 
and malnutrition in a country 
of abundance must be seen 
as consequences of a political 
and economic system that 
spends billions to remove 
food from the market, to limit 
production, to retire land 
from production, to guaran- 
tee and sustain profits for 
large producers of basic 

In July of 1968, the Senate re- 
sponded by appointing a Select Com- 
mittee on Nutrition and Human 
Needs, chaired by Senator George Mc- 
Govern, to lead "the war against hun- 
ger among the nation's young, old 
and poor. Over the next nine 
years, this committee initiated legisla- 
tion that expanded food assistance for 
families, children and the elderly. It 
also helped organize the 1969 "White 
House Conference on Food, Nutri- 
tion, and Health, a meeting that fo- 
cused national attention on the need 
to address problems of nutritional ade- 
quacy in the U.S.** 

In the the early 1970s, the commit- 
tee staff became aware of evidence 
that the typical American diet— high in 
fat, cholesterol, salt and sugar— might 
be related to the increasing preva- 
lence of chronic diseases. Much of 



this evidence came from the Ameri- 
can Heart Association (AHA), which 
had published reports on the role of 
dietary fat in atherosclerosis in the 
mid- 1 950s, ''"■ advice to reduce caloric 
intake from fat in 1961, and formal 
recommendations for dietary changes 
and public policies to reduce coro- 
nary heart disease risk factors in 
1970. These last recommendations 
had called for significant reductions in 
consumption of fat (to 35 percent of 
calories or less), saturated fat (to 10 
percent), and cholesterol (to 300 milli- 
grams per day. ) 

The Senate committee used this in- 
formation to initiate legislation that re- 
quired the National Institutes of 
Health to investigate nutritional com- 
ponents of the epidemiology, etiol- 
ogy, and prevention of coronary heart 
disease, diabetes and digestive dis- 
eases. The staff considered: 

. . . why so little was said 
about the relationship be- 
tween the American diet and 
the nation's health. Undernu- 
trition . . . was a problem for 
a small but significant part of 
the population. However, it 
was also apparent that malnu- 
trition had two faces and that 

overconsumption was a 
major health concern for at 
least 30 million Americans 


To address the issue of dietary 
overconsumption, the Senate commit- 
tee held hearings on dietary determi- 
nants of obesity, diabetes and heart 
diseases in 1973 and produced a staff 

report on nutrition and chronic dis- 
ease in 1974. In July of 1976, it held 
two hearings on "Diet Related to 
Killer Diseases," at which more than 
thirty witnesses discussed the role of 
American food consumption patterns 
in cancer cardiovascular disease and 

On the basis of this testimony, the 
committee issued its landmark staff re- 
port. Dietary Goals for the United 
States, at a press conference on Janu- 
ary 14, 1977: 

. . . this is the first compre- 
hensive statement by any 
branch of the Federal Govern- 
ment on risk factors in the 
American diet. The simple 
fact is that our diets have 
changed radically within the 
last 50 years. . . . These di- 
etary changes represent as 
great a threat to public health 
as smoking. Too much fat, 
too much sugar or salt, can 
be and are linked directly to 
heart disease, cancer, obesity, 
and stroke, among other 
killer diseases. 

Consistent with American Heart As- 
sociation recommendations, the re- 
port established six goals for dietary 
changes to improve health: 

• increase carbohydrate con- 
sumption to 55 to 60 percent 
of caloric intake; 

• decrease fat consumption (to 
30 percent); 


SUMMER 1990 

• reduce saturated fat and bal- 
ance with polyunsaturated and 
monounsaturated fats (to 10 
percent each); 

• reduce cholesterol consump- 
tion to about 300 milligrams 
per day; 

• reduce sugar consumption to 
15 percent of caloric intake; 

• reduce salt consumption to 
about three grams per day. 

To achieve these goals, the report 
recommended that Americans in- 
crease consumption of fruits, vegeta- 
bles, vv'hole grains, poultry and fish; 
decrease consumption of meat, eggs 
and foods high in fat, butterfat, sugar, 
and salt; substitute non-fat milk for 
whole milk; and partially substitute 
polyunsaturated fat for saturated fat. 

Because these recommendations 
called for significant changes in Ameri- 
can eating patterns, it was not surpris- 
ing that the commodity groups and 
food manufacturers most likely to be 
affected— cattlemen, egg producers, 
sugar interests, and the canning and 
dairy industries— reacted with strong 
protest.'* "Here, after all, was the 

Congress of the United States telling 

the public not to eat their products." 

Anticipating that nutrition scientists 
also might have objections, the com- 
mittee maintained that uncertainties in 
the science base should not detract 
from the recommendations: 

There will undoubtedly be 
many people who will say 
we have not proven our 
point; we have not demon- 

strated that the dietary modifi- 
cations we recommend will 
yield the dividends expected. 
We would point out to those 
people that the diet we eat 
today ... is a happenstance 
related to our affluence, the 
productivity of our farmers 
and the activities of our food 
industry. The risks associated 
with eating this diet are de- 
monstrably large. The ques- 
tion to be asked, therefore, is 
not why should we change 
our diet but why not?' 

The negative reactions of some sci- 
entists to the report have been sum- 
marized succinctly: 

Too soon, more research 
needed, relationships not 
proved; politically motivated; 
promises the public too 
much; my advice wasn't incor- 
porated; needs expert review 
. . . big brother approach; . . . 
iron deficiency may increase 
if less meat eaten; it's unwise 
to tamper with all the 
people's diets; I agree partly 
but it goes too far . . .; "A nu- 
tritional debacle. . . . " " 

The American Medical Association 
argued that it was inappropriate: 

for the government to adopt 
national goals that specify 
such matters as the amount 
and proportions of total fat, 
type of fat, sugar, cholesterol, 












Dietary Goals for the U.S., a 
report from the Senate Select 
Committee on Nutrition and 
Human Needs, recom- 
mended that Americans 
decrease caioric intake from 
fat by reducing consumption 
of animal fats and substitut- 
ing low-fat for high-fat dairy 
foods-suggestions that were 
not widely accepted by the 
food industry. 

(Reproduced with permis- 
sion from Dietary Goals for 
the United States: Food and 
Health, a publication of the 
American Heart Association, 
Alameda County Chapter, 
1978, p. 10.) 



or salt content in the diets of 
the general public. . . . Rather 
[we believe that] individual 
programs to prevent or to 
treat . . . would be the most 
effective means of improving 
the health of our American 
citizens . . . the recommenda- 
tions carry with them the un- 
derlying potential for . . . 
discouraging the agricultural 
production of certain food 
products which may not in 
the view of the government 
be supportive of the dietary 


The impact of these protests was 
immediate. "Pressure was brought to 
bear, especially, some claim, from the 
cattle industry in McGovern's home 
state of South Dakota."^'' The meat 
and egg producers demanded— and 
obtained— additional hearings to ex- 
press their views. In response, the 
committee produced a revised second 
edition later that year which strength- 
ened the recommendations on obe- 
sity and alcohol, but attempted to 
placate the food industry by increas- 
ing the salt recommendation from 
three to five grams per day; replacing 
the statement "reduce consumption of 
meat" with "choose meats, poultry, 

SUMMER 1990 

and fish which will reduce saturated 
fat intake;" and adding that "some 
consideration should be given to eas- 
ing the cholesterol goal for pre-meno- 
pausal women, young children and 
the eldedy in order to obtain the nutri- 
tional benefits of eggs in the diet." 

Despite such compromises, the Di- 
etary Goals proved a turning point. 
Although discounted at the time by 
many nutrition professionals, the re- 
port changed the course of nutrition 
education in the United States and be- 
came the basis of all subsequent di- 
etary recommendations. This 
accomplishment, however, was the 
last by the Select Committee on Nutri- 
tion and Human Needs. In February 
of 1977, shortly after release of the re- 
port, the Senate voted to "merge" 
McGovern's committee into a subcom- 
mittee of the Senate Committee on Ag- 
riculture, Nutrition, and Forestry as of 
the end of that year.' Subsequently, 
McGovern was defeated when he ran 
for re-election in 1980. 

Movement Toward Consensus 

Concerned about the biased argu- 
ments used by scientists who op- 
posed the Dietary Goals, the 
American Society for Clinical Nutri- 
tion, an organization of professionals 
engaged in human nutrition research, 
convened a task force in 1978 to re- 
view the strength of the evidence that 
related dietary factors to chronic dis- 
eases but would "avoid the advocacy 
role and . . . constitute a consensus 
that would be of help to public offi-_ 
cials in formulating national policy."' 

In its evaluation, the task force dem- 
onstrated for the first time that re- 
searchers had reached a substantial 
level of consensus on the role of di- 
etary fat, cholesterol, salt, sugar and 
alcohol as influencing the develop- 
ment of specific chronic diseases. 

Additional professional support for 
the Dietary Goals appeared in a 1978 
statement from the American Heart As- 
sociation, which reiterated its long- 
standing recommendations for reduc- 
tion of fat, saturated fat and choles- 
terol. In 1979, the National Cancer 
Institute issued similar recommenda- 
tions in its first tentative statement on 
the association of dietary factors with 
cancers at specific sites. Thus, lead- 
ing health agencies agreed that the 
two primary causes of death in the 
U.S. -coronary heart disease and can- 
cer—could be prevented at least in 
part by virtually identical dietary 

Healthy People In 1979, the De- 
partment of Health, Education, and 
Welfare (DHEW) issued Healthy Peo- 
ple: the Swgeon General's Report on 
Health Promotion and Disease Preven- 
tion in order to: 

. . . encourage a second pub- 
lic health revolution in the 
history of the United States. 
And let us make no mistake 
about the significance of this 
document. It represents an 
emerging consensus among 
scientists and the health 
community that the Nation's 
health strategy must be 


dramatically recast to empha- 
size the prevention of dis- 

In this report, public health offi- 
cials announced goals for a ten-year 
plan to improve national health. The 
nutrition section of this plan recom- 
mended diets with fewer calories; less 
saturated fat, cholesterol, salt, and 
sugar; relatively more complex carbo- 
hydrates, fish, and poultry; and less 
red meat. The report also noted that 
more than half of Americans' diet con- 
sisted of processed foods rather than 
fresh agricultural produce and that 
consumers should pay closer atten- 
tion to the nutritional qualities of such 

Although these recommendations 
did not include specific numerical tar- 
gets for intake of nutrients, any ad- 
vice to eat less red meat and to be 
wary of processed foods was certain 
to attract notice. To avoid contro- 
versy. Healthy People was released 
without a press conference in July of 
1979 as one of the final official acts of 
Joseph Califano, who had been fired 
from his position as Secretary of 
Health, Education, and Welfare by 
President Carter the month before. 
The meat industry's reaction was pre- 
dictable. Said David Stroud, president 
of the National Livestock and Meat 
Board: "The report begins with 'The 
health of the American people has 
never been better,' and we think it 
should have ended right there." 

Food Groups Revisited: The 
Basic Four Plus One. In attempting 

to devise menu plans that would 
meet both the RDAs and the Dietary 
Goals, USD A nutritionists stated that 
such diets "were so disruptive to 
usual food patterns" that they could 
not be adopted. Instead, they devel- 
oped Food: The Hassle-Free Guide to 
a Better Diet, a publication notable 
for its careful neutrality on issues of 
diet and health. For example: 

"Many scientists say the Amer- 
ican diet is contributing to 
some of the chronic diseases 
that hit people in later 
life. . . . Other scientists be- 
lieve just as strongly that the 
evidence doesn't support 
such conclusions. So the 

choice is yours. 


This publication displayed the 
fruit/ vegetable and bread/cereal 
groups above the dairy and meat 
groups. To help consumers make a 
choice, it added to the Basic Four a 
fifth group of foods— fats/sweets/alco- 
hol-that keep bad "nutritional com- 
pany" and are high in calories but 
low in essential nutrients and fiber. 

These alterations proved unaccept- 
able to the food industry. The USDA 
intended to follow the guide with a 
second publication that would ex- 
plain how to use food groups to main- 
tain appropriate body weight and 
reduce intake of fat and cholesterol. 
However, under pressure from the 
meat, dairy and egg industries, this 
publication was suppressed. The 
completed page boards were ob- 
tained by the American Dietetic 


SUMMER 1990 

Association, which published them as 
two separate booklets in 1982 


The Dietary Guidelines. In Feb- 
mary of 1980, ". . . with the fanfare of 
Moses unveiling the tablets," the 
USDA and DHEW announced joint 
publication of their consensus docu- 
ment, Nutrition and Your Health: Di- 
etary Guidelines for Americans. 
advising the public to "eat a variety of 
foods; maintain ideal weight; avoid 
too much fat, saturated fat, and cho- 
lesterol; eat foods with adequate 
starch and fiber; avoid too much 
sugar; avoid too much sodium; if you 
drink alcohol, do so in moderation." 

Because these guidelines were so 
general, they should have been ac- 
ceptable to the food industry. Indeed: 

. . . the Food Marketing Insti- 
tute (FMI), representing super- 
market chains, promised to 
distribute the Guidelines X.o 
its members, commenting 
that they are "simple, reason- 
able and offer great freedom 
of choice." Even the Ameri- 
can Meat Institute (AMI) 
called the Guidelines "help- 
ful," noting they provide "a 
continuing and central role 
lor meat. 

For other segments of the food in- 
dustry, however, even these recom- 
mendations went too far. Although 
the Guidelines 

ed. . . , the resulting outcry 
was unbelievable— charges 
and countercharges, editorials 
in prestigious newspapers, 
and Congressional hearings. 
All served to inflame the de- 
bate and obfuscate the real is- 
sues, i.e., are there reasons 
for changes in the national 
diet and, if so, how can these 
changes be accomplished? 

One commentator explained the es- 
sence of the controversy by noting 

the "political raison d'etre tor 
the Department of Agriculture 
is to make it easier for farm- 
ers to make money. And that 
purpose is not well served by 
permitting the people in 
Bethesda, Md., to run loose 
on such politically sensitive 
matters as red meat, butter, 

J „71 

and eggs. 

With criticisms that its recommenda- 
tions said both too little and too 
much, the Dietary Guidelines mighl 
simply have disappeared. Instead, 
this report soon became accepted as 
official federal nutrition policy. Two 
key events helped to consolidate its 
position: publication of a report from 
the NRC Food and Nutrition Board en- 
titled Toward Healthful Diets, and a 
federal directive to develop a revised 
second edition of the Guidelines 

were as mild a set of propos- 
als as has ever been draft- 

Toward Healthful Diets . In May 

of 1980, just three months after 


publication of the Dietary Guidelines, 
the NRC issued a report stating that 
there was no reason for the average 
healthy person to restrict dietary in- 
take of fat or cholesterol. This ad- 
vice was perceived widely as "... a 
sharp departure from the mainstream 
of recent dietary recommendations," " 
and it set off yet another round of pro- 
test. This time, however, federal agen- 
cies, consumer advocacy groups, 
nutrition scientists and Congressional 
committees were united in support of 
the Guidelines. In part, this support 
was generated by evidence that prepa- 
ration of Toward Healthful Diets was 
wholly financed by food industry do- 
nations and by concerns that at least 
two of the Food and Nutrition board 
scientists most closely connected to 
the report had strong ties to Indus- 


Dietary Guidelines: Second 
Edition. Shortly after the 1980 presi- 
dential election, in order to ensure 
that the government would speak 
with "one voice" on the role of diet in 
health, Congress directed the Secre- 
tary of USDA, in cooperation with the 
Department of Health and Human Ser- 
vices (formerly DHEW) and the NRC 
Food and Nutrition Board, to estab- 
lish a Guidelines Advisory Group to 
revise the Guidelines. ' Consumer 
groups subsequently pointed out that 
five of the six USDA nominees were 
closely connected to the food indus- 
try, and one of the two government 
representatives on the advisory com- 
mittee threatened to resign if any sub- 
stantial changes were made. By 

Nutrition and 
your Health 

Dietary Guidelines 
/1 1] Eat a Variety of 




Avoid Too Much Fat, 
Saturated Fat, and 
Cholesterol ^^c 1 1 

Eat Foods with 
Adequate Starch 
and Fiber c^t u 


If you Drink 
Alcohol, Do So In 
Moderation c^c i« 

Dietary Guidelines 
for Americans 

In Moderation oooe 2 

this time, however, the principal areas 
of controversy were close to resolu- 
tion. When the second edition ap- 
peared in 1985, it differed from the 
original in only three words. 

Draft proposals for the third edi- 
tion, to be published in 1990, should 
also prove acceptable to the food in- 
dustry. They rephrase the recommen- 
dations to make the tone more posi- 
tive (see Table) and address concerns 
"that certain foods are increasingly 
perceived as 'bad' and unfit for inclu- 
sion in the diet. . . . Any food that 
supplies calories and essential nutri- 
ents is recognized as potentially use- 
ful in a nutritious diet." 

This "total diet" approach permits 
consumption of meat and dairy prod- 
ucts and other foods that may be high 
in fat: 

These goals for fats apply to 
your diet over several days, 
not to a single meal or food. 

The second edition of the 
Dietary Guidelines for Ameri- 
cans (right) differed from the 
first (left) in only three 
words, but its elimination of 
numbers (which suggested 
priority order) and of the 
dark coloring in the number 
three (which seemed to em- 
phasize the need to reduce 
fat--and, therefore, meat and 
dairy-intake) made the sec- 
ond edition somewhat less 

{Reproduced with permis- 
sion from Nutrition and Your 
Health: Dietary Guidelines 
for Americans, first and sec- 
ond editions. Home and 
Garden Bulletin No. 32, Wash- 
ington, D.C.: USDA, 1980 
and 1985). 


SUMMER 1990 

Some foods that contain fat, 
saturated fatty acids, and cho- 
lesterol, such as meats, milk, 
cheese, and eggs, also con- 
tain high-quality protein and 
are our best sources of cer- 
tain vitamins and minerals. 

Disease-Specific Recommendations 

From 1980 to 1986, dietary recom- 
mendations proliferated and were ac- 
companied by increasing recognition 
of their fundamental similarity. Re- 
ports published by private and gov- 
ernmental agencies devoted to 
prevention or treatment of cancer, cor- 
onary heart disease, hypertension and 
diabetes offered substantial support 
for the general principles of the Di- 
etary Guidelines, as well as the nu- 
merical targets of the Dietary Goals. 

Cancer. The Food and Nutrition 
Board's 1982 report. Diet, Niitntioii, 
and Cancer, was the last set of di- 
etary recommendations to elicit wide- 
spread opposition. By proposing that 
cancer risk could be reduced by diets 
lower in fat ( 30 percent or less of calo- 
ries), higher in fiber, and restricted in 
alcohol and salt-cured foods such as 
bacon, hot dogs and sausages, the re- 
port generated unfavorable attention 
from Congressional representatives re- 
sponsive to industry and from meat 
producers who held the report respon- 
sible for the immediate fall in prices 
that followed its release. The report 
also was criticized by the new Secre- 
tary of Agriculture, John R. Block, 
who stated in his confirmation hear- 

Uaily rooD 

ings that "Fm not so sure government 
should get into telling people what 
they should or shouldn't eat." "* 
Some scientists were concerned that 
the evidence relating diet to cancer 

The USDA 's Hassle-Free 
Daily Food Guide elicited 
opposition from the food 
industry. It listed the vegeta- 
ble/fruit and bread/cereal 
groups above the dairy and 
meat groups, emphasized 
the desirability of reducing 
fat intake, and singled out 
red meat as especially high 
in fat. It was not reprinted. 

(Reproduced from the Hassle 
Free Daily Food Guide, Wash- 
ington, D.C., USDA, Science 
and Education Administra- 
tion, Leaflet No. 567, March 



was less than compelling. While they 
congratulated "the Committee for hav- 
ing compiled so readable a book on 
nutrition and cancer, they noted that 
the credibility of nutritional science is 
not enhanced by lowering the stan- 
dards for critical assessment of evi- 
dence. ' 

Viewing such statements as biased, 
the American Cancer Society sup- 
ported these recommendations in a 
special report of its own and the 
National Cancer Institute followed suit 
with similar dietary objectives and 
guidelines for cancer prevention. 

Coronary Heart Disease. The 

strongest support for the Dietary 
Goals and Guidelines continued to 
come from groups that addressed re- 
duction of risk factors for coronary 
heart disease. The American Heart As- 
sociation issued policy statements in 
1982,^'^ 1984''° and 1986'^' that reiter- 
ated numerical targets for intake of 
fat, cholesterol and salt. In 1983, the 
American Medical Association en- 
dorsed these targets, ~ as did a 1985 
NIH consensus panel. Shortly there- 
after, the National Heart, Lung, and 
Blood Institute (NHLBI) announced a 
national campaign to lower blood cho- 
lesterol levels with reduced fat intake 
as the first therapeutic step. "* Some 
clinicians argued that this effort was 
inappropriate for the general public 
and should be reserved for individu- 
als with high blood cholesterol levels 
as diagnosed by their physicians, ' 
but the NHLBI continued to pursue 
the campaign based on its conviction 

that the scientific support was over- 

Diabetes and Hypertension. In 

1979 and 1985 the American Diabetes 
Association issued numerical dietary 
targets for fat, complex carbohydrates 
and salt similar to those set forth in 
the Dietary Goals as a means to pre- 
vent and treat patients with diabe- 
tes.'^'' In 1984 and 1988, the NHLBI 
identified weight control and sodium 
and alcohol restriction as the most ef- 
fective dietary methods to prevent or 
treat high blood pres."^-ure and sup- 
ported what by then had become stan- 
dard numerical targets for reduction 
of cardiovascular risk factors. 

RDAs in the 1980s: the Delayed Tenth 

Despite the apparent unanimity of 
disease-specific recommendations, 
one last area of controversy remained 
to be resolved. As noted earlier, the 
RDAs had been developed as stan- 
dards for prevention of nutrient defi- 
ciencies in the population. The NRC 
Food and Nutrition Board delibera- 
tions during preparation of the tenth 
edition did not include consideration 
of research evidence on the role of 
diet in chronic disease. When the 
committee proposed to reduce the 
RDAs for vitamins A and C, it ignored 
potential conflicts with the Food and 
Nutrition Board's 1982 recommenda- 
tions to increase intake of foods con- 
taining these substances in order to 
prevent cancer. When challenged 
to explain the contradiction, members 
of the RDA committee stated that they 


SUMMER 1990 

"... did not think the scientific data 
should be interpreted primarily with 
policy in mind. " Unable to recon- 
cile the two sets of recommendations, 
the NRC rejected the RDA report and 
appointed a new committee to ". . . 
break the impasse and answer the un- 
resolved scientific questions. " This 
new committee released the tenth edi- 
tion in 1989 with recommendations 
for vitamins A and C largely un- 

Consensus achieved: 1988-1989 

In 1988 and 1989, the publication 
of three new reports indicated an ap- 
parent achievement of consensus. 
The authors of Desig)iing Foods, a re- 
port from the NRC Board on Agricul- 
ture, recommended a reduction in fat 
intake to 30 percent of calories. To 
do so, it challenged the meat industry 
to develop methods to raise beef with 
reduced fat content. Remarkably, 
this report had been requested by the 
USDA and produced with the full co- 
operation of the meat industry. In 
July of 1988, the Public Health Service 
released the Surgeon General's Report 
on Nutrition and Health, a 700-page, 
comprehensive review of research on 
diet and chronic disease that empha- 
sized the policy implications of its 
findings for nutrition education, ser- 
vices and research. This report 
was followed in March of 1989 by the 
even larger Diet and Health study 
from the NRC Food and Nutrition 
Board, which summarized the results 
of 5,000 research investigations. 
Authors of these last two reports 

came to similar conclusions and is- 
sued similar recommendations. 
Those of the Surgeon General's Re- 
port supported the general principles 
of the Dietaty Guidelines, whereas 
those of the Diet and Health study re- 
sembled the Dietary Goals. All three 
reports identified the need to reduce 
fat consumption as the primary prior- 
ity in public health nutrition efforts to 
prevent chronic disease. 

The release of each of these re- 
ports made front-page news and gen- 
erated widespread acclaim from 
nearly all segments of the nutrition 
community. The few dissenting com- 
ments on the Surgeon General's Re- 
port, for example, noted only that the 
report "... says little new and actu- 
ally retreats from positions taken ear- 
lier by federal and other agencies. 

The Changing Nutrition Environment 

For nearly seventy years, Atwater's 
1894 advice to reduce dietary fat to 
about 30 percent of calories was 
largely ignored. During that time, in- 
creasing centralization of agricultural 
production and distribution, expan- 
sion of the food industry, and knowl- 
edge of the role of nutrients in 
growth and longevity encouraged fed- 
eral nutritionists to emphasize con- 
sumption of sufficient foods to protect 
consumers against nutrient deficien- 
cies. Increasing recognition of the re- 
lationship between dietary patterns 
and chronic disease gradually created 
a climate more favorable to accep- 
tance of Atwater's original advice. 




Second Edition 

Proposed Third Edition 

Reason to Change 

Eat a variety of foods 


Maintain desirable 

Maintain healthy weight 



definition used 

Avoid too much fat, 

Choose a diet low in 

Focus on total diet 

saturated fat, and choles- 

fat, saturated fat, and 

in more positive 




Eat foods with 

Choose a diet with 

Focus on foods in the 

adequate starch and 

plenty of vegetables, 

total diet 


fruits, and grain 

Avoid too much sugar 

Use sugars in 

Focus on targeted 


foods in more 
positive way 

Avoid too much sodium 

Use salt and sodium in 

Focus on both in 


more positive way 

If you drink alcoholic 



beverages, do so in 


Proposed text changes for 
the third edition of the 
Dietary Guidelines for Ameri- 
cans. The new language 
implies that all foods are po- 
tentially useful in nutritious 
diets-even those high in fat, 
sugar, and salt. 

(Reproduced with permis- 
sion from Report of the 
Dietary Guidelines Advisory 
Committee on the Dietary 
Guidelines for Americans, 
1990, Human Nutrition 
Information Service, U.S. 
Department of Agriculture, 
May 14, 1990, p. 2). 

Despite recommendations by the 
American Heart Association in 1961 
and the Senate Select Committee in 
1977, consensus on the need to re- 
duce dietary fat was not achieved 
until the late 1980s. During that pe- 
riod, scientists debated the quality of 
the research evidence, health profes- 
sionals argued about the public's 
need for such advice, and the food in- 
dustry fought the economic implica- 
tions of dietary fat reduction. Yet 
these groups gradually came to 
accept and to support the recommen- 

To a considerable extent, this 
change in attitude can be attributed to 
greatly expanded scientific under- 
.standing of the role of diet in disease. 
Scientists in government and in the 
private sector eventually became con- 
vinced that the preponderance—and 
consistency—of evidence supported 
recommendations for dietary change. 

The increase in public interest in 
nutrition during the 1980s also 
affected receptiveness to dietary rec- 
ommendations. Consumer demands 
for information, purchase of foods 
perceived as healthy, and rejection of 


SUMMER 1990 

foods perceived as unhealthy, cre- 
ated a public base of support for fed- 
eral pronouncements on the role of 
diet in health. Finally, the food indus- 
try came to recognize the marketing 
potential of foods that meet dietary 
recommendations. It reduced oppc:)si- 
tion to such guidelines and instead 
began to use them to promote prod- 

Recommendations . . . will en- 
courage companies to de- 
velop products for nutrition 
conscious consumers . . . con- 
sumer demand has prompted 
food companies to call atten- 
tion to healthful properties of 
existing products and intro- 
duce a wide array of high 
fiber, low sodium, low fat 

and low cholesterol prod- 

, 108 

One index of the power of such 
views—and of the current consensus- 
is the new proposal by the Food and 
Drug Administration of a policy for 
mandatory nutrition laloeling that re- 
quires manufacturers of nearly all pro- 
cessed foods to list the content of fat, 
saturated fat, cholesterol and fiber in 
their products. The rules also pro- 
pose restrictions on claims that prod- 
ucts are low in cholesterol unless the 
foods are also low in fat. 

Issues for the 1990s 

With consensus on dietary recom- 
mendations virtually complete, the 
focus of attention now shifts to devel- 

opment of strategies to improve over- 
all patterns of dietary intake in the 
U.S. Although it might appear that 
Americans already have changed their 
eating patterns in response to dietary 
recommendations, evidence suggests 
that overall changes are minimal. For 
example, the total availability of fat in 
the U.S. food supply has risen steadily 
throughout this century and the avail- 
ability of saturated fat has remained 
unchanged for the past seventy 
years. Consumers have substimted 
skim for whole milk and butter for 
margarine, but they have more than 
compensated for such changes by in- 
creasing intake of cheese, frozen des- 
serts, processed meats, packaged 
foods and other sources of hidden fat. 

In the years ahead, government 
and health agencies will be seeking 
ways to improve nutrition education 
for the public, to bring the food pro- 
duction, marketing, and service sys- 
tems into compliance with dietary 
recommendations, and to increase the 
level of nutrition knowledge and prac- 
tice among physicians and other 

health professionals who advise the 

public about diet. Today, the tar- 
gets of dietary advice have shifted to 
include policymakers and food indus- 
try leaders as well as homemakers. 
The fundamental consistency of di- 
etary recommendations for healthy 
promotion and disease prevention, 
though long obscured by controversy, 
is now generally accepted. The pres- 
ent challenge is to find ways to en- 
courage food producers and 
consumers to practice what has so 
long been preached. 



1. Calla Van Syckle, "Some Pictures of 
Food Consumption in the United States," 
(Part I. 1630 to 1680, Part II. 1680 to 
1941), Journal of the Ameiican Dietetic As- 
sociation 21 (1945):508-514, 690-695. 

2. Norge W. Jerome, "The U.S. 
Dietary- Pattern from an Anthropological 
Perspective," Food Technology 35 (2) 
(1981): 37-42. 

3. Historical Statistics of the United 
States: Colonial Times to i970 (Washing- 
ton, DC: U.S. Department of Commerce, 
1975), 1175, provides data on food rations 
of American slaves, prisoners, ship passen- 
gers, and members of the armed forces. 

-t. U.S. Department of Health and 
Human Services and U.S. Department of 
Agriculture, Nutrition Monitoring in the 
United States: A Progress Report from the 
Joint Nutrition Monitoring Evaluation 
CoOTw/Wee (Washington, DC: U.S. Gov- 
ernment Printing Office, 1986). 

5. Historical Statistics, 58. 

6. For a critical analysis of such 
reports, see Harvey Levenstein, Resolution 
at the Table: The Transformation of the 
American Diet (New York: Oxford Uni- 
versity' Press. 1988), 109-120. 

7. "Advance Report of Final 
Mortality Statistics, 1987," Monthly Vital 
Statistics Report 37 (1)A19SS). 

8. See Ann A. Hertzler and Helen L. 
Anderson, "Food Guides in the United 
States," Journal of the America)! Dietetic 
Association (54(1974):19-28; Louise Light 
and Frances J. Cronin, "Food Guidance 
Revisited," Journal of Nutrition Education 
13 (1981):57-62; and Betsy Haughton, 
Joan D. Gussow, and Janice M. Dodds, 
"An Historical Study of the Underlying As- 
sumptions for United States Food Guides 

from 1917 through the Basic Four Food 
Group Guide," Journal of Nutrition Educa- 
tion i9(1987):l69-175. 

9. Department of Agriculture Organic 
Act, 12 Stat. 317, 15 May 1962. Also see 
Some Landmarks in the History of the De- 
partment of Agricultui-e (Washington, DC: 
Bureau of Agricultural Economics, Agricul- 
tural History Series No. 2; rev. January, 

10. W.O. Atwater, Foods: Nutritive 
Value and Cost. Farmers' Bulletin No. 23 
(Washington, DC: Government Printing 
Office, 1894), 25. 

11. W.O. Atwater, "Food and Diet," in 
Yearbook of the United States Department 
of Agriculture: 79S4 (Washington: Gov- 
ernment Printing Office, 1895), 371. 

12. W.O. Atwater, Foods: Nutritive 
Value and Cost, 26-28. The percentage 
figures are calculated from data on pp. 8 
and 18. 

13. See Elmer V. McCollum, History of 
Nutrition (Boston, MA: Houghton Mifflin, 

14. Caroline L. Hunt and Helen W. 
Atwater, How to Select Foods. I. What the 
Body Needs, Farmers' Bulletin 808 (Wash- 
ington, DC: USDA, March, 1917). 

15. Ibid, 1. 

16. Levenstein, Revolution at the Table, 

17. Ibid, H7-160. 

18. Caroline L. Hunt, Good Proportions 
in the Diet, Farmers' Bulletin No. 1313 
(Washington, DC: USDA, March, 1923), 1. 

19. U.S. Food Administration, Food 
and Wflr(Bo.ston. MA: Houghton Mifflin, 
1918), 262-281. 

20. See USDA publications, A Week's 
Food for an Average Family (Farmer's 

SUMMER 1990 

Bulletin 1228, December 1921); Food for 
Young Children (Farmers' Bulletin No. 
717, rev. June 1920); and A Guide to Good 
Meals for the Junior Homemaker (Misc. 
Circular No. 49, 1926). 

21. Hazel K. Stiebling and Medora M. 
Ward, Diets at Four Levels of Nutritive Con- 
tent and Cost, USDA Circular No. 296 
(Washington, DC: USDA, November 

22. For an analysis of this issue, see 
Haughton et ai, An Historical Study of 
the Underlying Assumptions. 171. 

23. See Lydia J. Roberts, "Beginnings 
of the Recommended Dietary Allow- 
ances," Journal of American Dietetic Asso- 
ciation 34(1 958) :903-908; Alfred E. 
Harper, "Origins of Recommended Di- 
etary Allowances—An Historical Over- 
view," American Journal of Clinical 
Nutrition 4i (1985):140-148. 

24. See Donald F. Miller and Leroy 
Voris, "Chronologic Changes in the Rec- 
ommended Dietary Allowances," Journal 
of American Dietetics Association 54 
(1969): 109-1 17. 

25. National Research Council, Recom- 
mended Dietary Allowances. 10th ed. 
(Washington, DC; National Academy of 
Sciences, 1989). 

26. See Joan D. Gussow and Paul R. 
Thomas, The Nutrition Debate: Sorting 
Out Some Answers(Vi\o Alto: Bull Pub- 
lishing Co., 1986), 18-61; "Minisympos- 
ium: Behind and Beyond the Recom- 
mended Dietary Allowances," Irwin H. Ro- 
senberg, ed., Americari Journal of Clini- 
cal Nutrition 41 (1985):139-170. 

27. Mary M. Hill and Linda E. Cleve- 
land, "Food Guides-Their Development 
and Use," Nutrition Program News (Wash- 
ington, DC: U.S. Department of Agricul- 
ture, July-October 1970). 

28. Office of Defense Health and Wel- 
fare Services, in U.S. Needs Us Strong 
(Washington, DC, 1942); Bureau of Home 

Economics, When You Eat Out: Food for 
/^reeiiow (Washington, DC: August, 1942). 

29. War Food Administration, Nutri- 
tion, and Food Conservation Branch publi- 
cation. National Wartime Nutrition Guide, 
NFC-4 (Washington, DC: USDA, July, 

30. Bureau of Human Nutrition and 
Home Economics, Agricultural Research 
Administration, Family Food Plans for 
Good Nutrition. AWl-78 (Washington, DC: 
USDA, December, 1943). 

31. Bureau of Human Nutrition and 
Home Economics, Agricultural Research 
Administration, National Food Guide. Leaf- 
let No. 288, formerly AIS-53 (Washington, 
DC: USDA, August, 1946). 

32. Bureau of Human Nutrition and 
Home Economics in cooperation with 
Farm Security Administration, Food for 
Growth: Food for Freedom, AWI-1 (Wash- 
ington, DC: U.S. Department of Agricul- 
ture, rev. October, 1946). 

33. Hill and Cleveland, Guides-Their 
Development and Use, 2. 

34. Ibid, 3. 

35. Agricultural Research Service, Essen- 
tials of an Adequate Diet . . . Facts for Nu- 
trition Programs, Home Economics 
Research Report No. 3, AIB-160 (Washing- 
ton, DC: USDA, November, 1956). 

36. Institute of Home Economics, Agri- 
cultural Research Service, Food for Fitness: 
A Daily Food Guide, Leaflet No. 424 
(Washington, DC: USDA, March, 1958). 

37. Eloise Cofer, Evelyn Grossman, 
and Faith Clark, Family Food Plans and 
Food Costs, Home Economics Research Re- 
port No. 20 (Washington, DC: USDA, No- 
vember, 1962). 

38. CBS television, "Hunger in Amer- 
ica," 1967. 

39. Citizens' Board of Inquiry into Hun- 
ger and Malnutrition in the United States, 
Hunger U.S.A. Revisited (New York: Field 
Foundation, 1972), 4. 



40. George McGovern, "Letter of Trans- 
mittal," Final Report of the Select Commit- 
tee on Nutrition and Human Needs 
(Washington, DC: U.S. Government Print- 
ing Office, December, 1977), 1. 

41. White House Conference on Food, 
Nutrition, and Health, Final Report (Wash- 
ington, DC: U.S. Government Printing Of- 
fice, 1970). 

42. Irvine H. Page, Fredrick J. Stare, 
A.C. Corcoran, Herbert Pollack, and 
Charles F. Wilkinson, "Atherosclerosis and 
the Fat Content of the Diet," Circulation 

43. Central Committee for Medical and 
Community Program of the American 
Heart Association, "Dietary Fat and its Re- 
lation to Heart Attacks and Strokes," Circu- 
lation 23 (I96l):133-i36. 

44. Inter-Society Commission for Heart 
Disease Resources, "Primary Prevention of 
the Atherosclerotic Diseases," Circulation 

45. James E. Austin and Christopher 
Hitt, Nutrition Inten>ention in the United 
States: Cases and Concepts (Cambridge, 
MA: Ballinger, 1979), 331. 

46. Select Committee, final Report. 

47. Select Committee on Nutrition and 
Human Needs, United States Senate, Di- 
etary Goals for the United States (Washing- 
ton, DC: U.S. Government Printing 
Office, February, 1977), 1. 

48. Ibid., 12-13. 

49. Select Committee on Nutrition and 
Human Needs, United States Senate, Di- 
etary Goals for the United States— Supple- 
mental Viras (Washington, DC: U.S. 
Government Printing Office, November, 

50. William J. Broad, "The Ever-Shifting 
Dietary Goals: Science 204 (1979): 1177. 

51. "Statement by D. Mark Hegsted," 
Select Committee, Dietary Goals. 3. 

52. A. Stewart Truiswell, "Evolution of 
Dietary Recommendations, Goals, and 
Guidelines," American Journal of Clinical 
Nutrition 45 (1987): 1060-1072. Also see 
Alfred E. Harper, "Dietary Goals~A Skepti- 
cal View," American Journal of Clinical 
Nutrition 31 (1978):310-321. 

53. Select Committee, Supplemental 
Views. 611. 

54. Broad, "The Ever-Shifting Dietary 
Goals: nil- 

55. Select Committee on Nutrition and 
Human Needs, United States Senate, Di- 
etari' Goals for the United States, 2nd ed. 
(Washington, DC: U.S. Government Print- 
ing Office, December, 1977), 4. 

56. William J. Broad, "NIH Deals Gin- 
gerly with Diet-Disease Link," Science 204 
(1979): 1175-1 178. 

57. "Report of the Task Force on the 
Evidence Relating Six Dietary Factors to 
the Nation's Health," American Journal of 
Clinical Nutrition 32 (1979):2627. 

58. American Heart Association Com- 
mittee on Nutrition, "Diet and Coronary 
Heart Disease," Circulation 58 

59. Arthur C. Upton, "Statement on 
Diet, Nutrition, and Cancer," Hearings of 
the Subcommittee on Nutrition, Senate 
Committee on Agriculture, Nutrition, and 
Forestry, 2 October 1979, GPO 56-1510 
(Washington, DC: U.S. Government Print- 
ing Office, 1979). 

60. U.S. Department of Health, Educa- 
tion, and Welfare. Healthy People: The 
Surgeon General's Report on Health Pro- 
motion and Disease Prevention, DHEW 
(PHS) 79-55071 (Washington, DC: U.S. 
Government Printing Office, 1979), vii. 
The first public health revolution was the 
fight against infectious diseases. 

61. The significance of a numerical tar- 
get (for example, 30 percent of calories 
from fat) is the dietary changes it requires. 
To meet this goal, consumers must reduce 


SUMMER 1990 

intake of beef, dairy products, and pro- 
cessed foods, in addition to added fats 
and oils. A more general statement to 
"eat less fat" leaves consumers free to set 
their own standards for comparison. 

62. Tom Monte, "The U.S. Finally 
Takes a Stand on Diet," Nutrition Action 6 
(9), (1979):4. 

63. Isabel D. Wolf and Betty B. Peter- 
kin, "Dietary Guidelines: The USDA Per- 
spective," Food Technology 38 (7), (1984): 

64. Science and Education Administra- 
tion, Food: The Hassle-Free Guide to a 
Better Diet, Home and Garden Bulletin 
228 (Washington, DC: U.S. Department 

of Agriculture, 1979), 3. 

65. "ADA to Publish Food II Magazine 
as Separate Booklets," CNI Weekly Report 
i2 (1982):l-2. 

66. Food 2: A Dieter's Guide, and 
Food 3: Eating the Moderate Fat and Cho- 
lesterol Way (Chicago: American Dietetic 
Association, 1982). 

67. Daniel S. Greenberg, "Nutrition: A 
Long Wait for a Little Advice," Science 

68. U.S. Department of Agriculture and 
U.S. Department of Health, Education, 

and Welfare, Nutrition and )'our Health- 
Dietary Guidelines for Americans." Home 
and Garden Bulletin No. 232 (Washing- 
ton, DC: U.S. Govemment Printing Of- 
fice, February, 1980). 

69. "USDA and HEW Unveil Guidelines 
for Healthy Eating," Community Nutrition 
Institute Weekly Report X ( 1980): 1-2. 

70. Sanford A. Miller and Marilyn G. 
Stephenson, "Scientific and Public Health 
Rationale for the Dietary Guidelines for 
Americans," American Journal of Clinical 
Nutrition 42 ( 1985):739-745. 

71. Greenberg, "Nutrition— A Long 
Wait," 536. The National Institutes of 
Health is located in Bethesda, Maryland. 

72. National Research Council, "To- 
ward Healthful Diets," (Washington, DC: 
National Academy of Sciences, 1980). 

73- See Jane E. Brody, "Sharp Depar- 
ture: U.S. Study Sees No Cause for Limit 
on Cholesterol," International Herald Tri- 
bune. May 29, 1980, 7. 

74. Philip Handler, "Statement on Di- 
etary Guidelines for Americans," U.S. Sen- 
ate Committee on Appropriations, Special 
Hearing, 96th Congress, 2nd Session 
(Washington, DC: July 16, 1980), 63-65. 
Also see Nicholas Wade, "Food Board's 
Fat Report Hits Fire," Science 209 ( 1980): 

75. U.S. Senate Committee on Appropri- 
ations, Agriculture, Rural Development, 
and Related Agencies Appropriations Bill, 
1981, Report 96-1030, 96th, Sec- 
ond Session (Washington, DC: November 
20, 1980), 38. 

76. "USDA Readies to Carve Up the Di- 
etary Guidelines," Nutrition Action 10 

77. Ronald Schwartz, "The Big Fuss 
Over Good Food," The New York Times, 
April 24, 1983. 

78. U.S. Department of Agriculture and 
U.S. Department of Health and Human 
Services, "Nutrition and Your Health: Di- 
etaiy Guidelines for Americans, " 2nd ed.. 
Home and Garden Bulletin No. 232 
(Washington, DC: U.S. Government Print- 
ing Office, 1985). "Maintain ideal weight" 
became "maintain desirable weight" and 
"alcohol" became "alcoholic beverages." 

79. Human Nutrition Information Ser- 
vice, Report of the Dietary' Guidelines Advi- 
sory Committee on the Dietary Guidelines 
for Americans, 1990. to the Secretary of 
Agriculture and the Secretary of Health 
and Human Senices (Washington, D.C.: 
USDA, May 14, 1990), 21. 

80. Ibid., 10. 

81 . National Research Council, Food 
and Nutrition Board, Diet, Nutrition, and 


Cawcer (Washington, DC: National Acad- 
emy Press, 1983). 

82. "Lawmakers Ask Probe of Diet-Can- 
cer Report," Community Nutrition Insti- 
tute Weekly Report 12 (4), (1982):6. 

83. Associated Press, "Diet Report Tied 
to Drop in Meat Price," San Francisco 
Chromcle]une 24, 1982, 6. 

84. Thomas M. Maugh, "Cancer Is Not 
Inevitable," Science 2i7(1982):36-37. 
Also see "USDA, HHS Disagree on Diet- 
Cancer Report, Community Nutrition Insti- 
tute Weekly Report 13 (22). (1983):1. 

85. Albert I. Mendeloff, "Appraisal of 
Diet, Nutrition, and Cancer," American 
Journal of Clinical Nutrition 37(1983): 
495-498. Also see: Michael W. Pariza, "A 
Perspective on Diet, Nutrition, and Can- 
cex," JAMA 251 (1984):1455-1458. 

86. American Cancer Society Special 
Report, "Nutrition and Cancer: Cause and 
Prevention," CA-A Cancer Journal for Cli- 
nicians 34 (2), (1984):121-126, 

87. Peter Greenwald and Edward J. 
Sondik, eds., Caticer Control Objectives 
for the Nation. 7985-2000 (Bethesda, MD: 
National Cancer Institute, 1986). 

88. Ritva Butrum, Carolyn K. Clifford, 
and Elaine Lanza, "NCI Dietary Guide- 
lines: Rationale," American Journal of 
Clinical Nutrition 48 (1988):888-895. 

89. American Heart Association Nutri- 
tion Committee, "Rationale of the Diet- 
Heart Statement of the American Heart As- 
sociation," Circulation 65 (4), 1982: 
839A- 854A. 

90. American Heart Association, "Rec- 
ommendations for Treatment of Hyperlip- 
idemia in Adults," Circulation 69 (5), 
(1984): 1067A-1090A. 

91. American Heart Association Posi- 
tion Statement, "Dietary Guidelines for 
Healthy American Adults," Circulation 74 

92. American Medical Association 
Council on Scientific Affairs, "Dietary and 

Pharmacologic Therapy for the Lipid Risk 
Factors," /AA'M 250 {T983):1873-1879. 

93. Consensus Conference, "Lowering 
Blood Cholesterol to Prevent Heart Dis- 
ease,", A4M4 253 (1985):2080-2086. 

94. Charles Marwick, "A Nation of Jack 
Sprats? Cholesterol Program to Stress Di- 
etary Changes," JAMA 25(3 (1986): 2775- 

95. Beverly Merz, "Low-Fat Diet May 
Be Imprudent for Some, Say Opponents 
of Population-Based Cholesterol Control," 
JAMA 255 (1986):2779-2780. 

96. "Report of the National Cholesterol 
Education Program Expert Panel on Detec- 
tion, Evaluation, and Treatment of High 
Blood Cholesterol in Adults," Archives of 
Internal Medicine 148 ( 1988):36-69. 

97. American Diabetes Association, 
"Principles of Nutrition and Dietary Rec- 
ommendations for Individuals with Diabe- 
tes Mellitus: 1979," Diabetes 28 (1979): 
1027-1030; and "Nutritional Recommenda- 
tions and Principles for Individuals with 
Diabetes Mellitus: 1986," Diabetes Care 

98. "The 1984 Report of the Joint Na- 
tional Committee on Detection, Evalua- 
tion, and Treatment of High Blood 
Pressure," Archives of Internal Medicine 
i44(1984):1045-1057. The 1988 update 
is in Archives of Internal Medicine 148 
(1988): 36-69. 

99. National Research Council, Diet, 
Nutrition, and Cancer, 1-16. 

100. See Robert Pear, "Lower Nutrient 
Levels Proposed in Draft Report on Ameri- 
can Diet," The Netv York Times, Septem- 
ber 23, 1985, 1. 

101. Robert Pear, "Impasse Delays Pro- 
posal to Cut Diet Guidelines," The New 
York Times, October 8, 1985, 1. Also see 
Eliot Marshall, "The Academy Kills a Nutri- 
tion Report," Science 230 (1985):420-421. 

102. National Research Council, Recom- 
mended Dietary Alloivances, 10th ed., 1-9. 


SUMMER 1990 

103. National Research Council, Board 
on Agriculture, Designing Foods: Animal 
Product Options in the Marketplace (Wash- 
ington, DC; National Academy of Science, 

104. Public Health Service, The Suigeon 
General's Report on Nutrition and Health 
(Washington, DC: Government Printing 
Office, 1988). 

105. National Research Council Food 
and Nutrition Board, Diet and Health: Im- 
plications for Reducing Chronic Disease 
Risk (Washington, DC: National Academy 
of Sciences, 1989). 

106. Michael F. Jacobson, Press State- 
ment CWashingion, DC: Center for Sci- 
ence in the Public Interest, July 27, 1988). 

107. See "New Product Parade Contin- 
ues," (Prepared Foods: Neiv Product An- 
nual, 1986), 12-20; Trends: Consumer 
Attitudes and the Supermarket (Washing- 
ton, DC: Food Marketing Institute, 1988). 

108. "Surgeon General's Dietary Recom- 
mendations Support Need for Health Mes- 
sages on Foods," (Washington, DC: TTie 
National Food Processors' Association, 
July 27, 1988). 

109. Philip J. Hilts, "U.S. Details Its Man- 
datory Food Labeling Plans," The New 
York Times. }u\y 13, 1990, B7. 

110. Economic Research Service. Food 
Consumption, Prices, and Expenditures, 
1966-1987. Statistical Bulletin No. 773 
(Washington, D.C.; USDA, January, 1989), 

111. J. Michael McGinnis and Marion 
Nestle, "The Surgeon General's Report on 
Nutrition and Health: Policy Implications 
and Implementation Strategies," American 
Journal of Clinical Nutrition 49(1989):23- 


Marion Nestle, Ph.D., M.P.H., is Profes- 
sor and Chair of the Department of Nutri- 
tion, Food and Hotel Management at New 
York University. Her degrees include a 
doctorate in molecular biology and a 
master's in public health nutrition from 
the University of California at Berkeley. 
She held the position of Associate Dean 
for Human Biology Programs at the Uni- 
versity of California School of Medicine in 
San Francisco, where she directed the 
John Tung/ American Cancer Society Clini- 
cal Nutrition Education Center, a training 
program for health professionals. From 
1986 to 1988, she was Staff Director for 
Nutrition Policy in the Office of Disease 
Prevention and Health Promotion at the 
Department of Health and Human Ser- 
vices in Washington, D.C. In this posi- 
tion, she served as Managing Editor of the 
1988 Surgeon General's Report of Nutri- 
tion and Health. Dr. Nestle is the author 
of Nutrition in Clinical Practice, a text- 
book for health professionals, and numer- 
ous scholarly articles. 

Donna Porter, Ph.D., R.D., is Specialist 
in Life Sciences at the Congressional Re- 
search Service of the Library of Congress 
in Washington, D.C. She took her Ph.D. 
in human nutrition from Ohio State Uni- 
versity. Prior to joining the Library, she 
was a Fellow at the National Nutrition 
Consortium in Washington and a Congres- 
sional Science Fellow assigned to the Sci- 
ence Policy Research Division of the 
Congressional Research Service. Dr. Por- 
ter is currently on sabbatical from the 
Library of Congress, and is Project Direc- 
tor of the Institute of Medicine's report on 
Nutrition Components of Food Labeling, 
released in September, 1990. 



"Russian America: 
Tlie Forgotten Frontier" 

A major exhibit undertaken by tiie 
Anchorage Museum of History and 
Art and the Washington State Histori- 
cal Society Museum, "Russian Amer- 
ica" is a record of Russian exploration 
in North America during the eigh- 
teenth and nineteenth centuries from 
the Bering Straits to Baja California. 
The special exhibit will run from No- 
vember 18, 1990 through February 10, 
1991, in Anchorage. Contact Curator 
Barbara Sweetland Smith at (907) 343- 
4326 for further information. 

"Crossroads of Continents: Cultures of 
Siberia and Alasl(a" 

The largest travelling exhibit ever 
developed by the Smithsonian Institu- 
tion, "Crossroads of Contintents" is a 
superb collection of more than 6OO ar- 
tifacts drawn from the Smithsonian's 
holdings and the Soviet Academy of 
Sciences. This exhibit is scheduled 
from October 21, 1990 through Febru- 
ary 24, 1991, at the Gene Autry West- 
em Heritage Museum in Los Angeles. 
Call (213) 667-2000 for details. 

■Medical Museums Association Annual 

The annual meeting of the Medical 
Museums Association (MeMA) is 
scheduled for May 1, 1991, in the 

Allen Memorial Medical Library, home 
of the Dittrick Museum, in Cleveland. 
A luncheon with the Association of Li- 
brarians in the History of the Health 
Sciences is planned. A three-hour 
workshop is being organized to focus 
on "Potential Health Hazards in Medi- 
cal Collections." Further information 
can be obtained from James Edmon- 
son, President, at (316) 368-3648. 

"Black Achievers in Science" 

Chicago's Museum of Science and 
Industry has organized a travelling ex- 
hibit which celebrates the achieve- 
ments of sixteen distinguished black 
American scientists. The exhibit is de- 
signed to inspire young people to 
choose careers in math, science and 
technology. A teachers' guide is pro- 
vided. Call Robert at Aztec in Wash- 
ington, D.C., (202) 372-1171, for 
specific information. The exhibit will 
travel to the following locations: 

Museum of Science in Boston, 
from October 13, 1990 to January 6, 
I99I; Museum of History and Science 
in Louisville, from January 26 to April 
21, 1991 ; and the Cumberland Science 
Museum in Nashville, from May 1 1 to 
August 4, 1991. 


American Heart Association 
Alameda County Chapter 

Center for Attitudlnal Healing 

The CORE Program 

Gay Men's Health Crisis (GMHC) 

David Lance Golnes 

William H. Helfand 

National Library of Medicine 

Philadelphia Museum of Art 

The William H. Helfand Collection 

US Department of Agriculture 

Cover illustration: Siflis. Spanish artist 
Ramon Casas used a woman with a 
snake climbing up her back to publicize a 
sanitarium in Barcelona for patients with 
venereal disease. (Courtesy of Philadel- 
phia Museum of Art: The William H. 
Helfand Collection.) 

Produced for the Department of Medical 
Humanities, Southern Illinois University 
School of Medicine by the Division of 
Biomedical Communications, Illustration 
Don Biggerstaff. Director of Biomedical 

Debra Vaninger, Design